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

Area of Science:

• Neurology
• Interventional Radiology
• Medical Device Technology

Background:

• Cerebral aneurysms pose significant risks, necessitating effective and safe treatment options.
• Endovascular procedures have emerged as a primary treatment modality, but standardized outcome metrics are lacking.

Purpose of the Study:

• To conduct a systematic review and meta-analysis of randomized controlled trials on endovascular treatment for cerebral aneurysms.
• To establish standardized outcome metrics for evaluating the effectiveness and safety of these procedures.

Main Methods:

• Systematic review and meta-analysis of 20 randomized controlled trials from MEDLINE, OVID, and Cochrane databases (up to May 2024).
• Evaluation of four key outcomes: major recurrence (Raymond-Roy scale ≥ 2b), retreatment rate, mortality rate, and modified Rankin Scale (mRS).
• Subgroup analysis based on endovascular techniques and patient urgency.

Main Results:

• Significant recurrence observed in 32.6% of cases, with 13.5% requiring retreatment.
• Favorable functional outcome (mRS ≤ 2) achieved in 88.2% of cases; mortality rate was 2.6%.
• Flow-diverter and intra-saccular devices showed higher recurrence rates; coil treatments had higher retreatment rates than clipping. Urgent patient cohorts had lower recurrence.

Conclusions:

• Established reference standards for endovascular aneurysm treatment effectiveness and safety.
• Provides benchmarks for evaluating novel endovascular procedures and improving clinical judgment.
• Enhances systematic assessment and promotes innovation in cerebral aneurysm treatment technologies.