Thrombectomy for Patients With Large-Volume Ischemic Stroke: A Systematic Review and Meta-Analysis of 6 Randomized...

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Large-volume strokes significantly impair patient function.
• Recent clinical trials have investigated endovascular interventions for stroke treatment.
• Endovascular thrombectomy (EVT) is a key intervention for acute ischemic stroke.

Purpose of the Study:

• To conduct a systematic review and meta-analysis of randomized trials evaluating EVT for large-volume cortical infarcts.
• To assess the efficacy and safety of EVT in improving functional outcomes for patients with large-volume strokes.

Main Methods:

• A comprehensive literature search of multiple databases (Medline, Embase, Scopus, etc.) was conducted in September-October 2024.
• Included randomized trials focused on large-volume strokes (ASPECTS 3-5, core volume >50 mL) treated with EVT.
• Meta-analysis used a random effects model to evaluate functional outcomes (modified Rankin Scale, ambulation, independence) and safety outcomes (hemorrhage).

Main Results:

• Six trials involving 1896 patients were analyzed; 50.2% received EVT.
• EVT significantly improved primary functional outcomes (OR=1.62) and secondary outcomes (OR=1.91, OR=2.49).
• EVT was associated with increased symptomatic and any intracranial hemorrhage (RR=1.66, RR=1.74) but not increased mortality or need for hemicraniectomy.

Conclusions:

• Endovascular thrombectomy (EVT) demonstrates significant benefit in improving functional outcomes for patients with large-volume strokes.
• The findings expand the established benefits of EVT to a broader range of stroke volumes.
• Standardization of EVT protocols is recommended for future research and clinical practice.