Mechanical Thrombectomy for Large Ischemic Stroke
Qi Li, Mohamad Abdalkader, James E. Siegler, Shadi Yaghi, Amrou Sarraj, Bruce Campbell, Albert J. Yoo, Osama O. Zaidat, Johannes Kaesmacher, Deep Pujara, Raul G. Nogueira, Jeffrey L. Saver, Lei Li, Qin Han, Yi Dai, Hongfei Sang, Qingwu Yang, Thanh N. Nguyen, Zhongming Qiu
Abstract
BACKGROUND AND OBJECTIVES: There is growing evidence for endovascular thrombectomy (EVT) in patients with large ischemic core infarct and large vessel occlusion (LVO). The objective of this study was to compare the efficacy and safety of EVT vs medical management (MM) using a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). METHODS: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0-3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42023396232). RESULTS: = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH. DISCUSSION: This systematic review and meta-analysis indicates that in patients with LVO stroke with a large ischemic core, EVT was associated with improved functional outcomes over MM without increasing sICH risk. The results of ongoing RCTs may provide further insight in this patient population.