Long-term Efficacy and Safety of Endovascular Thrombectomy for Acute Ischemic Stroke with Large Vessel Occlusion: A Systematic Review and Meta-Analysis
Muhammad Osama1, Sufyan Shahid2, Muhammad Abdullah Ali1, Soban Qasim3, Megha Joshi4, Muhammad Shaheer Bin Faheem5
1Khyber Medical College, Peshawar, Pakistan, 2Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan, 3Multan Medical and Dental College, Multan, Pakistan, 4CityMD, New York, NY, 5Karachi Institute Of Medical Sciences, Karachi
Objective:
We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of endovascular thrombectomy (EVT) beyond 90 days in patients of acute ischemic stroke (AIS) with large vessel occlusion (LVO).
Background:
EVT improves functional outcomes in patients of acute ischemic stroke at 90 days. However, its long-term efficacy and safety beyond 90 days remain uncertain.
Design/Methods:
PubMed, Embase, Scopus, and Cochrane Central databases were searched to identify randomized controlled trials (RCTs) comparing EVT plus medical therapy (MT) versus MT alone in AIS patients with LVO. Primary outcomes included functional independence (mRS ≤2), independent ambulation (mRS ≤3), death or dependency (mRS 4-6) and all-cause mortality beyond 90 days. We applied a random effects model and pooled risk ratios (RRs) along with 95% confidence interval (CI) using RevMan 5.4. Quality assessment was performed using the Rob2 tool.
Results:
Six RCTs with 1,856 patients (57% males) were included. The mean age of the patients was 68.9 years and mean follow up duration was 1.08 years. The results showed that EVT combined with MT improved functional independence (mRS ≤2) (RR 2.41, CI: 1.52-3.83; P = 0.0002), independent ambulation (mRS ≤3) (RR 1.76, CI: 1.31-2.37; P = 0.0002), and quality of life (SMD 0.43; CI: 0.26-0.59; P < 0.00001) beyond 90-days compared to MT alone. Moreover, the EVT plus MT group also had a significantly reduced death or dependency (mRS 4-6) (RR 0.77, CI: 0.71-0.83; P < 0.00001) and all-cause mortality (RR 0.86, CI: 0.77-0.96; P = 0.005) beyond 90-days than MT group. All RCTs were rated as low risk of bias.
Conclusions:
EVT combined with medical treatment significantly improves long-term functional outcomes and quality of life as well as reduces mortality in AIS patients with LVO than medical treatment alone.
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