Setting benchmark for ischemic stroke treated endovascularly: a systematic review and meta-analysis

A comparative study was conducted to assess the effectiveness and safety of endovascular procedures for treating cerebral aneurysms with the aim of establishing standardized outcome metrics. A comprehensive systematic review and meta-analysis was performed on randomized controlled trials extracted from the MEDLINE, OVID, and Cochrane databases through May 2024. Out of the initial 1637 articles, 20 studies were selected based on stringent inclusion criteria (1.2%). Four key outcomes were evaluated: major recurrence (characterized by a Raymond-Roy scale ≥ 2b [RR]), retreatment rate, mortality rate, and modified Rankin Scale (mRS). In addition, the results were categorized and analyzed according to various endovascular techniques in a subgroup analysis. The I^2 values were high with a ranged between 86.93% and 98.54%. The follow-up periods ranged from 6 to 18 months. Significant recurrence was observed in 32.6% of cases (95% confidence interval [CI], 18.5 to 46.6), with retreatment necessary in 13.5% (95% CI, 8.6 to 18.3). An mRS score of ≤ 2 was achieved in 88.2% (95%CI 84.1 to 92.4)of cases, while the mortality rate was 2.6% (95% CI, 1.6 to 3.6). FD and intra-saccular devices exhibited notably higher RR ≥ 2b. The coil trials demonstrated significantly higher retreatment rates than the clipping trials. The Flow-diverter group showed a higher proportion of mRS scores ≤ 2. Studies focusing solely on urgent patients have shown considerably lower RR ≥ 2b rates. These established reference standards act as benchmarks for evaluating novel endovascular procedures, enabling a more systematic assessment of their effectiveness and safety profile. This approach improves the caliber of the evidence, supports clinical judgment, and promotes innovation in treatment technologies.