Introduction Endovascular treatment (EVT) replaced medical management (MM) alone in patients with small- to medium-sized infarct core secondary to occlusion of large vessels in the anterior circulation; however, its efficacy and safety for large core infarction is uncertain. In this meta-analysis, we aimed to investigate the efficacy and safety of EVT for patients with large core infarct.

Materials and Methods Three online databases of Web of Science, PubMed and Scopus were systematically searched. Original studies which evaluated participants with large core infarction who underwent EVT were included. R statistical software was used for statistical analyses. Effect sizes were presented with odds ratios (ORs) with their 95% confidence intervals (CIs). The effect sizes were pooled using random effects modeling.

Results Including 47 studies and 15173 patients, this meta-analysis showed that compared with MM, EVT was associated with decreased odds of mortality (0.67, 95% CI: 0.51-0.87) and increased odds of favorable outcomes, including a modified Rankin Scale of 0-3(2.36, 95% CI: 1.69 -3.291) and of 0-2 (3.54, 95% CI: 1.96-6.4) in 90 days and remarkable improvement in National Institutes of Health Stroke Scale within 48 hours after the procedure (3.6, 95% CI:1.32-9.79). Besides, there was a higher chance of intracranial hemorrhage development (1.88, 95% CI: 1.32-2.68) but not symptomatic hemorrhages (1.34, 95% CI: 0.78-2.31) in those who underwent EVT.

Conclusion Our study suggests that EVT might be an effective and relatively safe treatment option for the treatment of patients with large core infarcts, although more large-scale trials are needed to consolidate the results and to make inclusion criteria and the patient selection process clearer.

Disclosures A. Mowla: 2; C; Speakers Bureau/Consultant to Cerenovus, Stryker, Wallaby Medical, RapidAI , BALT USA,LLC.. 3; C; Speakers Bureau/Consultant to Cerenovus, Stryker, Wallaby Medical, RapidAI , BALT USA,LLC.. S. Abdollahifard: None. E. Taherifard: None. A. Sadeghi: None. P. Rakhshandeh Hassan Kiadeh: None. O. Yousefi: None.