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Endovascular thrombectomy for large-core stroke: a meta-analysis with trial sequential analysis.

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Endovascular thrombectomy improves outcomes for large-core stroke patients but increases bleeding risk. Non-contrast CT with CTA may help select suitable candidates for this effective treatment.

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Area of Science:

  • Neurology
  • Interventional Radiology
  • Medical Imaging

Background:

  • Large-core stroke requires effective treatment to improve patient outcomes.
  • Endovascular thrombectomy (ET) is a potential intervention for acute ischemic stroke.
  • Evidence on ET's efficacy and safety in large-core stroke is evolving.

Purpose of the Study:

  • To systematically review and meta-analyze the efficacy and safety of ET versus best medical treatment (BMT) in large-core stroke.
  • To compare neurological outcomes, functional independence, and safety profiles between ET and BMT.
  • To assess the role of specific imaging modalities in patient selection for ET.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) published up to November 2023.
  • Inclusion criteria: RCTs comparing ET with BMT in large-core stroke (ASPECTS < 6 or ischemic core > 50 mL) within 24 hours.
  • Searched PubMed/MEDLINE, Scopus, and Cochrane databases; included 6 RCTs with 1,887 patients.

Main Results:

  • ET significantly improved good neurological outcomes (OR: 2.92) and independent walking (OR: 2.22).
  • Trial sequential analysis confirmed robust statistical significance favoring ET for good neurological outcomes.
  • ET was associated with increased risks of intracranial bleeding (OR: 2.65) and symptomatic intracranial bleeding (OR: 1.83); no differences in mortality or decompressive craniectomy.
  • Patients screened with non-contrast CT and CTA showed comparable good outcomes (OR: 3.24).

Conclusions:

  • Endovascular thrombectomy is associated with improved neurological outcomes and independent walking in patients with large-core acute ischemic stroke.
  • ET increases the risk of intracranial bleeding, necessitating careful patient selection.
  • Non-contrast head CT with CT angiography appears appropriate for screening patients eligible for endovascular thrombectomy.