Endovascular Treatment in Large Vessel Stroke Patients in Early vs Late Window: Systematic Review and Meta-Analysis
Ahmed Shaheen1, Belal Hamed2, Nour Shaheen1, Hafsa Arshad Azam Raja3, Ram Saha4
1Alexandria Faculty of Medicine, 2Faculty of Medicine Al-azahr Cairo university, 3Rawalpindi Medical University, Rawalpindi, Pakistan, 4Virginia Commonwealth University
Objective:
To compare endovascular therapy (EVT) outcomes in large vessel occlusion (LVO) stroke patients by comparing early (0-6 hours) versus late (6-24 hours) treatment windows.
Background:
The effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) within 6–24 hours after last known well (LKW) remains unclear. This study compares EVT outcomes in early (0-6 hours) versus late (6-24 hours) stages for LVO stroke patients.
Design/Methods:
We conducted a systematic review and meta-analysis of studies comparing early and late EVT for LVO. Outcomes included modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and modified Thrombolysis in Cerebral Infarction (mTICI) scores. Odds ratios (OR) and mean differences (MD) were calculated using random-effects models where appropriate.
Results:
Eight studies were included. Early neurological outcomes (NIHSS) showed a statistically significant difference favoring early EVT (MD= 2.45, 95% CI: 2.00 to 2.91). Late neurological outcomes (mRS 0-2) also significantly favored early EVT (OR= 4.49, 95% CI: 3.21 to 6.29), with 55% achieving good outcomes in the early group versus 47% in the late group. Reperfusion rates (mTICI ≥ 2b) showed no statistical difference between groups (OR=2.04, 95% CI: 0.73 to 5.68). After resolving heterogeneity, the fixed effect model remained non-significant (OR=1.17, 95% CI: 0.91 to 1.51).
Conclusions:
Our meta-analysis demonstrated statistically significant differences favoring early EVT for both early and late neurological outcomes in LVO patients. However, reperfusion rates were similar between groups. Importantly, a significant percentage of late window patients still benefited from EVT regarding late neurological outcomes, supporting its use in this time frame.
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