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

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.