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

To develop standardized benchmarks for evaluating endovascular treatment of ischemic stroke by analyzing treatment efficacy and safety. This allows the comparison of new techniques and devices with solid standards and quality control.

We conducted a systematic review and meta-analysis of randomized controlled trials from the MEDLINE, OVID, and Cochrane databases from January 2015 (MRCLEAN trial published date) to June 2025, focusing on predefined clinical outcomes. After applying the inclusion and exclusion criteria, 35 studies were included from the initial search of 1949 (1.8%). The benchmarks selected were modified treatment for ischemic cerebral infarction (mTICI)≥2b, modified Rankin Scale (mRS)≤2, symptomatic hemorrhagic transformation rate, and death rate. According to concept of confidence of interval (CI) 95%, everything that falls outside the border is defined as statistically significant.

The I² rages from 61.6% to 93.86%. The mTICI≥2b rate was 75.5% (95% CI: 75.7 to 81.5), the mRS≤2 was 43.5% (95% CI: 40.0 to 47.2), with a symptomatic hemorrhagic transformation rate of 5.4% (95% CI: 4.5 to 6.4), and a death rate of 18.4% (95% CI: 16.2 to 20.8) at three months. Subgroup analysis suggest trend in favour of higher mTICI≥2b rate intra-arterial thrombolysis+MT vs. MT. The mRS≤2 rate was lower in the large core trial and higher in the intra-arterial thrombolysis+MT.

The derived benchmarks served as reference standards for assessing new endovascular treatments and quality control. This methodology enhances the quality of evidence, aids in clinical decision-making, and fosters advancements in treatment technologies.