Endovascular treatment (EVT) for acute ischemic stroke (AIS) patients presenting with
National Institutes of Health Stroke Scale score of 0 to 5 is common in clinical practice
but has not yet been proven safe and effective. Our objective is to assess whether
EVT on top of best medical treatment (BMT) in AIS patients with large-vessel occlusion
of the anterior circulation presenting with mild symptoms is beneficial compared with
BMT.We searched MEDLINE, SCOPUS, and reference lists of retrieved articles published
until December 28, 2022. A systematic literature search was conducted to identify
clinical trials or observational cohort studies evaluating patients with AIS due to
anterior circulation large-vessel occlusion and admission National Institutes of Health
Stroke Scale score ≤5 treated with EVT versus BMT alone. The primary outcome was excellent
functional outcome (modified Rankin Scale score 0-1) at 3 months. The protocol had
been registered before data collection (PROSPERO).Eleven observational eligible studies
were included in the meta-analysis, comprising a total of 2019 AIS patients with National
Institutes of Health Stroke Scale score ≤5 treated with EVT versus 3171 patients treated
with BMT. EVT was not associated with excellent functional outcome (risk ratio, 1.10
[95% CI, 0.93-1.31]). When stratified for different study design (per-protocol versus
intention-to-treat), there were no significant subgroup differences. EVT was not associated
with good functional outcome (modified Rankin Scale score 0-2; risk ratio, 1.01 [95%
CI, 0.89-1.16]) or reduced disability at 3 months (common odds ratio, 0.92 [95% CI,
0.60-1.41]). Symptomatic intracranial hemorrhage was more common in the patients receiving
EVT (risk ratio, 3.53 [95% CI, 2.35-5.31]). No correlation was found between EVT and
mortality at 3 months (risk ratio, 1.34 [95% CI, 0.83-2.18]). The same overall associations
were confirmed in the sensitivity analysis of studies that performed propensity score
matching.EVT appears equivalent to BMT for patients with anterior circulation large-vessel
occlusion AIS with low baseline National Institutes of Health Stroke Scale, despite
the increased risk for symptomatic intracranial hemorrhage.URL: https://www.crd.york.ac.uk/PROSPERO/;
Unique identifier: CRD42022334417.
