Current guidelines recommend endovascular treatment (EVT) for acute ischaemic stroke
(AIS), due to large-vessel occlusion and an Alberta Stroke Program Early CT Score
(ASPECTS) of ≥6. High-quality evidence resulting from randomised controlled clinical
trials (RCTs) regarding EVT among large-core AIS has recently become available, justifying
an updated meta-analysis aiming to evaluate efficacy and safety of EVT in this clinical
setting.We conducted a systematic review and meta-analysis including all available
RCTs that compared EVT in addition to best medical treatment (BMT) versus BMT alone
for large-core AIS (defined by ASPECTS 2-5 or volumetric methods). The primary outcome
was reduced disability at 3 months (≥1-point reduction across all Modified Rankin
Scale (mRS) grades). Secondary outcomes included independent ambulation at 3 months
(mRS score 0-3), good functional outcome at 3 months (mRS score 0-2), excellent functional
outcome at 3 months (mRS score 0-1), symptomatic intracranial haemorrhage (sICH) and
any intracranial haemorrhage (ICH) and mortality at 3 months. The random-effects model
was used.Four RCTs were included comprising a total of 662 patients treated with EVT
vs 649 patients treated with BMT. Compared with BMT, EVT was significantly associated
with reduced disability (common OR 1.70, 95% CI 1.39 to 2.07; I2=0%), independent
ambulation (risk ratio (RR) 1.69, 95% CI 1.33 to 2.14; I2=39%) and good functional
outcome (RR 2.33, 95% CI 1.76 to 3.10; I2=0%), but not with excellent functional outcome
(RR 1.46, 95% CI 0.91 to 2.33; I2=39%) at 3 months. Although rates of sICH (RR 1.98,
95% CI 1.07 to 3.68; I2=0%) and any ICH (RR 2.13, 95% CI 1.70 to 2.66; I2=37%) were
higher in the EVT group, 3-month mortality (RR 0.98, 95% CI 0.83 to 1.15; I2=0%) did
not differ between the two groups.EVT appears to be effective and safe and may be
considered for the treatment of large-core AIS, as assessed by ASPECTS of 2-5 or volumetric
methods.CRD42022334417.
