Abstract Details

Title Endovascular Thrombectomy Versus Standard Medical Treatment Alone in Patients With Acute Ischemic Stroke With Large Infarct (ASPECTS = 5): a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-010

Objective To compare the efficacy, risk of bleeding, and risk of mortality between endovascular thrombectomy (EVT) and standard medical treatment (SMT) alone in patients with acute ischaemic stroke (AIS) with moderate to low ASPECTS.

Background Evidence suggests increased benefits of EVT in AIS with large infarct in comparison with SMT alone. A previous meta-analysis evaluated the impact of EVT in AIS with extreme low ASPECTS (≤2). However, there is no current comparative meta-analysis evaluating the effect of EVT in AIS with moderate to low ASPECTS (≤5).

Design/Methods Medline, Embase, and Cochrane databases were systematically searched until June 2024, assessing randomized controlled trials (RCTs) comparing EVT and SMT alone in patients with AIS with ASPECTS ≤5. Primary outcomes included successful reperfusion and modified Rankin scale (mRS). Secondary outcomes included death from any cause, intracranial hemorrhage, and EQ-5D-5L Utility Index. R Studio was used for statistical analysis.

Results Five RCTs were included in this meta-analysis, comprising 1586 patients, with 795 patients receiving EVT. Successful reperfusion was achieved in 78.65% (95% CI 73.05% - 84.24%; I² = 61%) of the patients in EVT. There was a statistically significant difference favorable to EVT regarding mRS 0-2 (RR 2.71; 95% CI 2.04 - 3.61; I² = 0%) and mRS 0-3 (RR 2.04; 95% CI 1.52 - 2.74; I² = 62%). In the EVT group, death from any cause was lower (RR 0.82; 95% CI 0.68 - 0.99; I² = 43%), intracranial hemorrhage was higher (RR 1.65; 95% CI 1.04 - 2.62; I² = 0%), and the EQ-5D-5L Utility Index was higher (MD 0.20; 95% CI 0.12 - 0.28; I² = 0%).

Conclusions EVT is an effective treatment for large infarctions, showing better neurological functional outcomes and reduced mortality compared to SMT alone. However, it shows a higher risk of intracranial hemorrhage, which is an important aspect to take into consideration.

Authors/Disclosures
Marina Vilardo PRESENTER	Miss Vilardo has nothing to disclose.
Anthony Hong, MD	Dr. Hong has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
Ana Santos, MD	Ms. Santos has nothing to disclose.
Matheus Felipe Henriques Brandão (Nova Esperança Faculty of Medicine)	No disclosure on file
Gabriel d. Monteiro	Mr. Monteiro has nothing to disclose.
Luma R. Silva	Miss Silva has nothing to disclose.
Arlindo B. Junior, MD Student	Mr. Junior has nothing to disclose.
Gabriel Simoni, MD	Mr. Simoni has nothing to disclose.
Kairo Igor Freitas de Aquino	Mr. Freitas de Aquino has nothing to disclose.
Pedro Barreto Pires Bezerra Filho (Universitary Center of João Pessoa)	No disclosure on file
Marcio Y. Ferreira, MD	Dr. Ferreira has nothing to disclose.
Savio Batista, MD (Emory University)	Mr. Batista has nothing to disclose.
Victor G. Soares, MS	Mr. Soares has nothing to disclose.
Vitor Ribeiro Gonçalves (Santa Casa de Belo Horizonte)	No disclosure on file
Kelson J. Almeida, PhD	Prof. Almeida has nothing to disclose.

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