Ischemic stroke from large vessel occlusion (LVO) in the anterior circulation poses significant risks, including high mortality and adverse neurological outcomes. Previous studies have evaluated CA versus SR, but the superior treatment remains uncertain.
We conducted systematic searches in PubMed, Cochrane, and Embase databases comparing CA and SR in patients with LVO in the anterior circulation. Studies provided data on reperfusion success and mortality rates. Pooled analyses used fixed and random effects models, calculating 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using RStudio, version 4.4.1.
A total of 20 studies involving 8,166 patients were included in the meta-analysis. Results indicated that patients treated with CA achieved significantly higher reperfusion rates, as measured by Thrombolysis in Cerebral Infarction (TICI) scores, compared to those treated with SR, especially for excellent reperfusion (TICI 3) (OR = 1.39; 95% CI: 1.01-1.91; p < 0.05; I² = 84%). The Modified TICI scores (2B-3), which indicate successful reperfusion, were also more favorable for CA, with the First Pass yielding (OR = 1.422; 95% CI: 1.007-2.007; p = 0.045; I² = 71%), while the End of Procedures demonstrated (OR = 2.18; 95% CI: 1.74-2.74; p < 0.00001; I² = 72%), indicating enhanced reperfusion throughout the procedure. No significant difference in mortality was observed (OR = 1.00; 95% CI: 0.87-1.14; p = 0.47; I² = 0%).
This meta-analysis indicates that CA provides a superior clinical response compared to SR, enhancing reperfusion without affecting 90-day mortality in patients with ischemic stroke from large vessel occlusion in the anterior circulation. Further research is needed to explore long-term implications.