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Background:
Systematic Review

Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials

by
Michele Romoli
1,*,
Lucia Princiotta Cariddi
2,
Marco Longoni
1,†,
Gianluca Stufano
1,
Sebastiano Giacomozzi
1,
Luca Pompei
2,
Francesco Diana
3,†,
Lucio D’Anna
4,5,†,
Simona Sacco
6,† and
Simone Vidale
2,†
1
Department of Neurosciences, AUSL Romagna, Bufalini Hospital, 47521 Cesena, Italy
2
Department of Neurology, ASST Sette Laghi, 21100 Varese, Italy
3
Neuroradiologia Intervencionista, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain
4
Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College London NHS Healthcare Trust, London W6 8RF, UK
5
Department of Brain Sciences, Imperial College London, London W6 8RF, UK
6
Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
*
Author to whom correspondence should be addressed.
†
Senior authors.
J. Clin. Med. 2024, 13(15), 4280; https://doi.org/10.3390/jcm13154280
Submission received: 2 April 2024 / Revised: 11 June 2024 / Accepted: 26 June 2024 / Published: 23 July 2024
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
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Abstract

Background/Objectives: Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6. Randomized controlled trials (RCTs) have recently become available on EVT effects in people with LVO-related large core stroke (ASPECTS 0–5). Here, we provide an updated meta-analysis of the EVT effect on functional neurological status in people with large-core stroke. Methods: The study followed the PRISMA guidelines. PubMed, EMBASE and Cochrane Central were searched for RCTs comparing EVT vs. best medical treatment (BMT) in large-core LVO stroke. The primary outcome was functional independence at 90 days (modified Rankin Scale; mRS 0–2). The secondary outcomes were symptomatic intracranial hemorrhage (sICH), good functional outcome (mRS 0–3) and excellent functional outcome (mRS 0–1). EVT vs. BMT was compared through random effect meta-analysis. Heterogeneity was assessed with the I2 and Q test and risk of bias reported according to the RoB2 tool. Results: Six RCTs were included (n = 1656 patients). All studies had a moderate risk of bias, with blinding bias due to the nature of the intervention, potential allocation bias and incomplete outcome reporting. Functional independence was significantly more frequent in the EVT vs. BMT group (OR = 2.47, 95% CI = 1.52–4.03, p < 0.001). sICH rates (OR = 1.77, 95% CI = 1.01–3.11, p = 0.04) and good functional outcome (OR = 2.20; 95% CI = 1.72–2.81, p < 0.001) were more frequent in the EVT vs. BMT group, while the rates of mRS 0–1 did not differ. Conclusions: In patients with large-core stroke and LVO, EVT plus BMT as compared to BMT alone carries a significant increase in independent ambulation and good functional outcome at 3 months despite the marginal increase in sICH.
Keywords: large ischemic stroke; mechanical thrombectomy; meta-analysis; RCTs large ischemic stroke; mechanical thrombectomy; meta-analysis; RCTs

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MDPI and ACS Style

Romoli, M.; Princiotta Cariddi, L.; Longoni, M.; Stufano, G.; Giacomozzi, S.; Pompei, L.; Diana, F.; D’Anna, L.; Sacco, S.; Vidale, S. Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2024, 13, 4280. https://doi.org/10.3390/jcm13154280

AMA Style

Romoli M, Princiotta Cariddi L, Longoni M, Stufano G, Giacomozzi S, Pompei L, Diana F, D’Anna L, Sacco S, Vidale S. Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine. 2024; 13(15):4280. https://doi.org/10.3390/jcm13154280

Chicago/Turabian Style

Romoli, Michele, Lucia Princiotta Cariddi, Marco Longoni, Gianluca Stufano, Sebastiano Giacomozzi, Luca Pompei, Francesco Diana, Lucio D’Anna, Simona Sacco, and Simone Vidale. 2024. "Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials" Journal of Clinical Medicine 13, no. 15: 4280. https://doi.org/10.3390/jcm13154280

APA Style

Romoli, M., Princiotta Cariddi, L., Longoni, M., Stufano, G., Giacomozzi, S., Pompei, L., Diana, F., D’Anna, L., Sacco, S., & Vidale, S. (2024). Mechanical Thrombectomy in Ischemic Stroke with a Large Infarct Core: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Medicine, 13(15), 4280. https://doi.org/10.3390/jcm13154280

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