Background Previous randomized controlled trials (RCTs) and meta-analyses were underpowered in demonstrating the superiority of endovascular thrombectomy (EVT) over medical therapy (MEDT) in the treatment of acute ischemic stroke due to large vessel occlusion of the posterior circulation (PC-LVO). We performed an updated systematic review and meta-analysis after the publication of the BAOCHE and ATTENTION trials to determine whether EVT can benefit patients presenting with PC-LVO.
Methods Using Nested Knowledge, we screened literature for RCTs on EVT in PC-LVO. The primary outcome was 90-day modified Rankin Scale (mRS) 0-3, and secondary outcomes included 90-day mRS 0-2, 90-day mortality, and rate of symptomatic intracranial hemorrhage (sICH). A random-effects model was used to compute rate ratios (RRs) and their corresponding 95% confidence intervals (CI).
Results Four RCTs with 988 patients, 556 patients in the EVT arm and 432 patients in the MEDT arm, were included in the meta-analysis. EVT resulted in significantly higher rates of mRS 0-3 (RR = 1.54; 95% CI: 1.16-2.04; p = 0.002) and functional independence (RR = 1.83; 95% CI: 1.08-3.08; p = 0.024), and lower rates of mortality (RR = 0.76; 95% CI: 0.65-0.90; p = 0.002) at 90-day follow-up compared to MEDT alone. However, EVT patients had higher rates of sICH (RR = 7.48; 95% CI: 2.27-24.61; p < 0.001).
Conclusions EVT conferred significant patient benefit over MEDT alone in the treatment of PC-LVO. Future studies should better define patients in whom EVT is futile and determine factors that contribute to higher rates of sICH.
Disclosures G. Adusumilli: None. H. Kobeissi: None. S. Ghozy: None. N. Hardy: 4; C; Nested Knowledge, Inc. 5; C; Nested Knowledge, Inc. K. Kallmes: 4; C; Nested Knowledge, Inc, Superior Medical Experts, Inc. 5; C; Nested Knowledge, Inc, Conway Medical LLC. K. Hutchison: 5; C; Nested Knowledge, Inc. D. Kallmes: 1; C; MicroVention, Medtronic, Balt, Insera Therapeutics. 2; C; Vesalio. 4; C; Nested Knowledge, Inc, Superior Medical Experts, Inc, Conway Medical LLC, Marblehead Medical, Piraeus Medical. 6; C; Medtronic. W. Brinjikji: 2; C; Johnson & Johnson, Stryker, Medtronic, MicroVention. 4; C; Marblehead Medical. 6; C; MIVI Neurovascular. G. Albers: 2; C; iSchemaView, Genentech. 4; C; iSchemaView. J. Heit: 2; C; Medtronic, MicroVention. 6; C; iSchemaView.
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