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Updated: Nov 5, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical thrombectomy versus medical care alone in large ischemic core: An up-to-date meta-analysis
Qianmei Jiang1, Huaishun Wang1, Jian Ge1
1Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Insights
Mechanical thrombectomy improves outcomes for acute ischemic stroke patients with small infarct cores (low ASPECTS), showing better functional outcomes and lower mortality without increased bleeding risk. For large infarct cores, outcomes were similar between thrombectomy and medical management.
Area of Science:
- Neurology
- Interventional Cardiology
- Stroke Medicine
Background:
- Acute ischemic stroke (AIS) patients with large infarct cores present unique treatment challenges.
- Mechanical thrombectomy and medical management are primary treatment options for AIS.
- The efficacy and safety of thrombectomy in patients with large infarct cores require further investigation.
Purpose of the Study:
- To compare the outcomes and adverse events of mechanical thrombectomy versus medical management in AIS patients.
- To specifically analyze results in patients with a large infarct core, defined by ASPECTS <=7 or ischemic core volume >=50 ml.
Main Methods:
- A systematic literature search was conducted across Ovid MEDLINE, Cochrane Library, and EMBASE up to January 2021.
- Studies included were those comparing mechanical thrombectomy with medical management alone in AIS patients with large infarct cores.
- Functional outcome was assessed using the modified Rankin Scale (mRS) score (0-2 at 90 days/discharge); safety endpoints included mortality and symptomatic intracranial hemorrhage (sICH) or parenchymal hematoma type 2 (PH2).
Main Results:
- Fourteen studies comprising 2547 patients were analyzed.
- In patients with low ASPECTS, thrombectomy was associated with significantly better functional outcomes (OR=3.47) and lower mortality (OR=0.62) compared to medical management alone, with no significant difference in sICH or PH2 rates.
- For patients with large core volumes, no statistically significant differences in functional outcomes or safety endpoints were observed between thrombectomy and medical management groups.
Conclusions:
- Mechanical thrombectomy is safe and effective in carefully selected AIS patients with low ASPECTS.
- Further research is needed to identify contraindications for mechanical thrombectomy, particularly in AIS patients with large core volumes.
- Patient selection remains critical for optimizing thrombectomy outcomes in AIS.
Objective:
We compared outcomes and adverse events of thrombectomy versus medical management in acute ischemic stroke (AIS) patients with baseline large infarct core.
Methods:
We searched Ovid MEDLINE(R) ALL, Cochrane Library Clinical Controlled Trials and EMBASE from inception to January 2021 for studies comparing thrombectomy and medical management alone in AIS patients who had ASPECTS <=7 or ischemic core volume >=50 ml. Imaging modalities to valuate ASPECTS and core volume were without restriction. The functional outcome was measured by mRS (modified Rankin Scale) score 0-2 at 90 days or discharge. The safety end point included the rates of mortality and sICH (symptomatic intracranial hemorrhage) or PH2 (parenchymal hematoma type 2).
Results:
Fourteen studies with a total of 2547 patients (thrombectomy n = [1197]; medical care alone [n = 1350]) fulfilled our criteria. As for patients with low ASPECTS, pooled results indicated a higher odds of good functional outcome (OR = 3.47; 95% CI 1.99 to 6.07; P < 0.0001, I2=66%) and a lower risk of mortality (OR = 0.62; 95% CI 0.46 to 0.83; P = 0.001, I2=32%) in thrombectomy group compared with no thrombectomy group, but the risk of sICH or PH2 did not differ between two groups. As for patients with large core volume, both functional outcome and safety end point between two groups showed no statistically significant difference.
Conclusion:
Thrombectomy remained safe and effective by careful selection in patients with low ASPECTS. More studies were warranted to explore contraindications for mechanical thrombectomy in AIS patients, especially in patients with large core volume.
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