Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

Abstract

It remains controversial as to whether mechanical thrombectomy (MT) is safer and more beneficial in patients with large vessel occlusion stroke (LVOS) presenting with a National Institutes of Health Stroke Scale score ≤ 8. We therefore conducted a meta-analysis of the published data.We searched PubMed and Embase and pooled relevant data in the meta-analyses using fixed effects models. Only studies that directly compared best medical therapy alone (BMT) with MT were included. We used odds ratios to analyze the associations between MT and 90-day functional outcome (evaluated using the modified Rankin Scale (mRS)), mortality, and rates of symptomatic intracerebral hemorrhage (sICH) in patients with LVOS and minor symptoms. Five studies including a total of 581 patients met our inclusion criteria. A significant difference was found that the patients treated with MT were associated with improved 90-day mRS score (OR, 1.68; 95% CI, 1.08–2.61) compared with BMT group. There was no difference in 90-day mortality between the two groups. However, sICH occurred more frequently in the MT group than the BMT group (OR, 3.89; 95% CI, 1.83–8.27). Patients with LVOS with minor or mild symptoms who underwent primary thrombectomy had a significantly improved 90-day mRS score compared to those who received BMT alone. Meanwhile, the risk of sICH was higher in the MT group than that in BMT group. Future randomized clinical controlled trials evaluating the role of endovascular reperfusion for LVOS with minimal symptoms are warranted.

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

“…A similar observation was made in a multi-center cohort described by Haussen et al Here, the authors found that mechanical thrombectomy in patients presenting with NIHSS ≤ 5 was associated with higher rates of functional independence and a favorable NIHSS shift when compared to medical management alone [34]. These findings were corroborated by a recent meta-analysis suggesting improved outcome in patients with NIHSS ≤ 8 if treated with thrombectomy as opposed to best medical treatment [41]. However, in this analysis, increased rates of sICH after endovascular therapy were found, warranting further data [41].…”

“…These findings were corroborated by a recent meta-analysis suggesting improved outcome in patients with NIHSS ≤ 8 if treated with thrombectomy as opposed to best medical treatment [41]. However, in this analysis, increased rates of sICH after endovascular therapy were found, warranting further data [41]. Importantly, in the presented cohort, the rates of sICH were markedly lower (4.2%) than the proportion of patients experiencing sICH described in the meta-analysis (13.6%) [41].…”

Impact of leukoaraiosis severity on the association of outcomes of mechanical thrombectomy for acute ischemic stroke: a systematic review and a meta-analysis

“…According to demographic profiles, there were significant between-group differences in the age (64. 6 . Regarding stroke mechanism, there were no significant between-group differences in large artery atherosclerosis (28.3% vs. 20.5%; OR, 1.43; 95% CI 0.87-2.36); however, there were significant differences in cardioembolic (48.2% vs. 73.8%; OR, 0.28; 95% CI 0.10-0.77).…”

“…This is the highest available evidence level of a treatment technique available according to the latest guidelines from American Heart Association/ American Stroke Association (AHA/ASA) [2]. Moreover, indications for MT have been recently expanded to benefit more patients, including a longer time window [3][4][5], lower National Institutes of Health Stroke Scale (NIHSS) score [6], larger infarct cores [7], and elderly patients [8]. However, the reported rate of good post-MT functional outcome (modified Rankin Scale [mRS] score of 0-2 at 90 days) was < 50% [1].…”

Efficacy and Safety of Mechanical Thrombectomy for Acute Mild Ischemic Stroke with Large Vessel Occlusion

“…Current guidelines state that patients with an NIHSS score of 6 or higher should receive EVT, while patients within 3 h of experiencing mild disabling stroke should receive IVT [ 21 ]. Meta-analyses on the therapeutic effect of MT alone or in combination with rt-PA on AMIS patients with an NIHSS score of 5 or lower have demonstrated that both approaches improved the 3-month functional outcomes of AMIS patients with LVO [ 22 , 23 ].…”