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Updated: Jun 11, 2025

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Thrombectomy for patients with a large infarct core: a study-level meta-analysis with trial sequential analysis

Hong-Jie Jhou1,2, Li-Yu Yang2,3, Po-Huang Chen4

  • 1Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.

Therapeutic Advances in Neurological Disorders
|October 10, 2024
PubMed

Insights

Endovascular thrombectomy significantly improves functional outcomes for stroke patients with large infarct cores but increases the risk of symptomatic intracranial hemorrhage (SICH). Further research is needed to clarify other safety outcomes.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Public Health

Background:

  • Effectiveness and safety of endovascular treatment vs. medical management for large infarct core strokes remain uncertain.
  • Large vessel occlusion strokes represent a significant public health challenge requiring optimized treatment strategies.

Purpose of the Study:

  • To compare clinical outcomes of mechanical thrombectomy against best medical care in patients with large infarct core strokes.
  • To evaluate the efficacy and safety of endovascular thrombectomy in improving functional outcomes and reducing mortality.

Main Methods:

  • Systematic review and meta-analysis of six randomized controlled trials.
  • Searches conducted in PubMed, Cochrane, and Embase up to November 8, 2023.
  • Primary outcome: functional outcomes at 3 months; safety outcomes: mortality, symptomatic intracranial hemorrhage (SICH), decompressive craniectomy.

Main Results:

  • Thrombectomy significantly improved neurological prognosis, with increased odds of good (OR 2.90) and favorable (OR 2.40) functional outcomes at 3 months.
  • No significant reduction in mortality rates observed with thrombectomy (OR 0.78).
  • Increased incidence of SICH in the thrombectomy group (5.5% vs. 3.2%; OR 1.77).

Conclusions:

  • High-quality evidence suggests thrombectomy significantly mitigates disability in large infarction patients.
  • Thrombectomy increases the risk of symptomatic intracranial hemorrhage.
  • Trial sequential analysis confirmed favorable functional outcomes but yielded inconclusive results for other safety endpoints.
Abstract

Keywords:
a large infarct coreacute ischemic strokemeta-analysisthrombectomy

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