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Meta-Analysis
. 2024 Oct 12;13(1):255.
doi: 10.1186/s13643-024-02670-6.

Endovascular thrombectomy after anterior circulation large vessel ischemic stroke: an updated meta-analysis

Seraj Makkawi  1   2   3 , Jawad I Bukhari  4   5 , Hassan K Salamatullah  4   5 , Osama A Alkulli  4   5 , Abdulrahman E Alghamdi  4   5 , Asim Bogari  4   5 , Naif M Aloufi  4   5 , Mohammed Albadri  4   5 , Fay N Alnafisi  4   5 , Saeed Alghamdi  6
Affiliations
Meta-Analysis

Endovascular thrombectomy after anterior circulation large vessel ischemic stroke: an updated meta-analysis

Seraj Makkawi et al. Syst Rev. .

Abstract

Background: Endovascular thrombectomy (EVT) has emerged as the established standard of care for the treatment of anterior circulation large-vessel occlusion (LVO). However, its benefits remain unclear in specific patient populations. Herein, we present an updated systematic review and meta-analysis aimed at thoroughly assessing the effectiveness and safety of combining EVT with medical treatment (MT) compared with MT alone.

Methods: This systematic review was performed in accordance with the PRISMA guideline. The MEDLINE, Embase, and Cochrane databases were systematically searched to identify relevant articles published until December 30, 2023. The inclusion criteria restricted articles to randomized clinical trials (RCTs). We pooled odds ratios (OR) and their respective 95% confidence intervals (CIs).

Results: Fifteen RCTs involving 3897 patients were included in the study. EVT plus MT was associated with a significant reduction in disability at 90 days (OR = 1.91, [1.61-2.26]), improved functional independence (modified Rankin Scale [mRS] 0-2) (OR = 2.19 [1.81-2.64]), excellent functional outcomes (mRS 0-1) (OR = 2.37, [1.45-3.87]), improved independent ambulation (mRS 0-3) (OR = 2.17, [1.75-2.69]), and higher rates of partial/complete recanalization (OR = 2.18, [1.66-2.87] compared with EVT. Efficacy outcomes for both large and small infarct cores were statistically favorable following EVT. Safety outcomes showed comparable rates, except for intracerebral and subarachnoid hemorrhage, which favored MT alone.

Conclusion: This meta-analysis supports the use of EVT plus MT as the standard of care for acute ischemic stroke patients with LVO of any infarct core size, as it offers substantial improvements in functional outcomes and recanalization. Safety considerations, particularly the risk of hemorrhage, warrant careful patient selection. These findings provide valuable insights for optimizing stroke management protocols and enhancing patient outcomes.

Keywords: Anterior circulation; Endovascular thrombectomy; Large vessel ischemic stroke; Meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Efficacy outcomes. A mRS ordinal shift distribution at 90 days. B mRS 0–1. C mRS 0–2. D mRS 0–3. E ENI. F Barthel Index score
Fig. 3
Fig. 3
Forest plot of sub-group analysis based on infarct core size showing the odds of functional independence (mRS 0–2)
Fig. 4
Fig. 4
Forest plot of sub-group analysis based on infarct core size showing the rates of partial/complete recanalization
Fig. 5
Fig. 5
Safety outcomes. A Any intracerebral hemorrhage. B Symptomatic intracranial hemorrhage (sICH). C Mortality at 90 days. D Early neurological worsening (ENW)
See this image and copyright information in PMC

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