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Endovascular treatment versus medical management for mild stroke with acute anterior circulation large vessel occlusion: a meta-analysis
  1. Bin Qin,
  2. Yunli Zhang,
  3. Shuolin Liang,
  4. Huo Liang,
  5. Shiting Tang,
  6. Zhijian Liang
  1. Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
  1. Correspondence to Dr Zhijian Liang, Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China; liangzhijian{at}


Background The effectiveness of endovascular treatment (EVT) in patients with mild stroke (National Institutes of Health Stroke Scale score ≤5) and acute anterior circulation large vessel occlusion (AACLVO) remains unknown.

Objective To conduct a meta-analysis to compare the efficacy and safety of EVT in patients with mild stroke and AACLVO.

Methods EMBASE, Cochrane Library, PubMed, and databases were searched until October 2022. Both retrospective and prospective studies which compared the clinical outcomes between EVT and medical treatment were included. ORs and 95% confidence intervals (CIs) for excellent and favorable functional outcomes, symptomatic intracranial hemorrhage (ICH), and mortality were pooled using a random-effects model. A propensity score (PS)-based methods adjusted analysis was also performed.

Results 4335 patients from 14 studies were included. In patients with mild stroke and AACLVO, EVT presented no marked differences in excellent and favorable functional outcomes and mortality compared with medical treatment. A higher risk of symptomatic ICH (OR=2.79; 95% CI 1.49 to 5.24; P=0.001) was observed with EVT. Subgroup analysis revealed that EVT had potential benefit for proximal occlusions with excellent functional outcomes (OR=1.68; 95% CI 1.01 to 2.82; P=0.05). Similar results were observed when PS-based methods adjusted analysis was used.

Conclusion EVT did not significantly benefit clinical functional outcomes in comparison with medical treatment in patients with mild stroke and AACLVO. However, it may improve functional outcomes when treating patients with proximal occlusion, despite being associated with an increased risk of symptomatic ICH. Stronger evidence from ongoing randomized controlled trials is required.

  • Stroke
  • Intervention
  • Thrombectomy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • BQ and YZ contributed equally.

  • Contributors BQ and ZL: interpretation of the data, critical revision of the manuscript, and conception and design of the study. BQ, YZ, SL, and ZL: literature search, data extraction, and drafting the original manuscript. HL, ST, and BQ: data analysis, drafting the figures and tables, and revision of the manuscript. ZL is the guarantor of the entire study.

  • Funding This research was sponsored by the National Natural Science Foundation of China (82260243) and National Key R&D Program of China (No. 2018YFC1311305).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.