GRADE evidence profile for PICO 8.
| Certainty assessment | № of patients | Effect | Certainty | Importance | ||||||||
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | EVT using direct Aspiration as the first-line strategy | Stent retriever as the first-line strategy | Relative (95% CI) | Absolute (95% CI) | ||
| Successful Recanalization (TICI 2b-3); TICI: Thrombolysis in Cerebral Ischemia: Observational studies | ||||||||||||
| 12 | Non-randomized studies | Serious* | Not serious | Not serious | Not serious | None | 527/602 (87.5%) | 731/899 (81.3%) | OR 1.57 (1.15 to 2.15) | 59 more per 1000 (from 20 more to 90 more) | ⨁◯◯◯Very low | IMPORTANT |
| mRS 0–3 at 90 days: Observational studies | ||||||||||||
| 4 | Non-randomized studies | Serious* | Not serious | Not serious | Serious† | None | 120/259 (46.3%) | 171/404 (42.3%) | OR 1.19 (0.87 to 1.64) | 43 more per 1000 (from 34 fewer to 123 more) | ⨁◯◯◯Very low | CRITICAL |
| Favorable outcome (mRS 0–2) at 90 days: Observational studies | ||||||||||||
| 13 | Non-randomized studies | Serious* | Not serious | Not serious | Not serious | None | 242/607 (39.9%) | 314/928 (33.8%) | OR 1.34 (1.07 to 1.67) | 68 more per 1000 (from 15 more to 122 more) | ⨁⨁◯◯Low | IMPORTANT |
| Symptomatic Intracranial Hemorrhage (sICH): Observational studies | ||||||||||||
| 8 | Non-randomized studies | Serious* | Not serious | Not serious | Serious† | None | 17/445 (3.8%) | 48/671 (7.2%) | OR 0.62 (0.34 to 1.13) | 26 fewer per 1000 (from 46 fewer to nine more) | ⨁◯◯◯Very low | IMPORTANT |
| Mortality at 90 days: Observational studies | ||||||||||||
| 8 | Non-randomized studies | Serious* | Not serious | Not serious | Not serious | None | 135/451 (29.9%) | 204/666 (30.6%) | OR 0.82 (0.61 to 1.11) | 40 fewer per 1000 (from 94 fewer to 23 more) | ⨁◯◯◯Very low | IMPORTANT |
*Serious risk of bias due to serious confounding reported in some of these studies implemented for this outcome according to ROBINS-I tool for observational studies.
†Serious imprecision due to low optimal information size. The total number of patients included is less than the number of patients generated by a conventional size sample calculation for a single adequately powered clinical trial.
CI, confidence interval; EVT, give details; mRS, modified Rankin Scale; OR, odds ratio.