# Endovascular thrombectomy for large-core stroke: a meta-analysis with trial sequential analysis

## TL;DR

Endovascular thrombectomy improves neurological outcomes in large-core stroke patients but increases bleeding risks.

## Contribution

A meta-analysis and trial sequential analysis evaluating ET efficacy and safety in large-core stroke patients.

## Key findings

- ET improves good neurological outcomes (OR: 2.92) and independent walking (OR: 2.22) in large-core stroke patients.
- ET increases risks of intracranial bleeding (OR: 2.65) and symptomatic intracranial bleeding (OR: 1.83).
- Non-contrast CT with CTA scans show comparable outcomes to other imaging modalities for ET screening.

## Abstract

Recent studies have reported that endovascular thrombectomy (ET) may improve neurological outcomes in large-core stroke.

We performed a systematic review and meta-analysis to compare the pooled efficacy and safety of ET and of the best medical treatment among patients with large-core stroke.

We searched the PubMed/MEDLINE, Scopus, and Cochrane databases from inception to November 2023. The inclusion criteria were randomized controlled trials (RCTs) comparing ET and the best medical treatment available among patients with large-core stroke (Alberta Stroke Program Early Computed Tomography Score [ASPECTS] < 6 or ischemic core > 50 mL on perfusion imaging) within 24 hours of symptom onset.

We included 6 RTCs comprising 1,887 patients (ET group:
n
 = 945). Endovascular thrombectomy was associated with good neurological outcomes (odds ratio [OR]: 2.92; 95% confidence interval [95%CI]: 2.17–3.93), or independent walking (OR: 2.22; 95%CI: 1.72–2.86). Trial sequential analysis confirmed a robust statistical significance for good neurological outcomes favoring ET. Endovascular thrombectomy was associated with higher risks of developing intracranial bleeding (OR: 2.65; 95%CI: 1.35–5.22) and symptomatic intracranial bleeding (OR: 1.83; 95%CI: 1.14–2.94). There were no differences between the groups regarding mortality or decompressive craniectomy. Patients submitted to non-contrast computed tomography (CT) with CT angiography (CTA) scans were analyzed separately and showed good neurological outcomes, comparable to those of the patients submitted to other imaging modalities (OR: 3.24; 95%CI: 1.52–6.92).

Endovascular thrombectomy was associated with good neurological outcomes and independent walking in patients with large-core acute ischemic stroke. However, it was also associated with an increased risk of developing intracranial bleeding. Non-contrast head CT with CTA scans may be appropriate for screening patients to undergo ET.