In:
Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 94, No. 10 ( 2023-10), p. 781-785
Abstract:
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. Methods 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. Results 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; I 2 =0%), independent ambulation (risk ratio (RR) 1.69, 95% CI 1.33 to 2.14; I 2 =39%) and good functional outcome (RR 2.33, 95% CI 1.76 to 3.10; I 2 =0%), but not with excellent functional outcome (RR 1.46, 95% CI 0.91 to 2.33; I 2 =39%) at 3 months. Although rates of sICH (RR 1.98, 95% CI 1.07 to 3.68; I 2 =0%) and any ICH (RR 2.13, 95% CI 1.70 to 2.66; I 2 =37%) were higher in the EVT group, 3-month mortality (RR 0.98, 95% CI 0.83 to 1.15; I 2 =0%) did not differ between the two groups. Conclusion 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. PROSPERO registration number CRD42022334417.
Type of Medium:
Online Resource
ISSN:
0022-3050
,
1468-330X
DOI:
10.1136/jnnp-2023-331513
Language:
English
Publisher:
BMJ
Publication Date:
2023
detail.hit.zdb_id:
1480429-3
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