Endovascular treatment in acute ischemic stroke patients with pre-stroke disability: A systematic review and meta-analysis.
Lucca Tamara Alves Carretta, Mariana Letícia de Bastos Maximiano, Rudolfh Batista Arend et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis compared endovascular thrombectomy (EVT) with best medical treatment in acute ischemic stroke patients with pre-stroke disability (mRS 2–4). Five studies included 1,400 patients. EVT was associated with lower all-cause mortality (OR: 0.49, 95% CI: 0.29-0.82, p = .007) and greater odds of returning to baseline mRS (OR: 3.21, 95% CI: 2.02-6.09, p < .001). Symptomatic intracranial hemorrhage was numerically more frequent with EVT, but the difference was not statistically significant.
Key findings
- Across five studies and 1,400 patients, EVT was associated with lower all-cause mortality than best medical treatment (OR: 0.49, 95% CI: 0.29-0.82, p = .007).
- EVT was associated with greater odds of return to baseline mRS (OR: 3.21, 95% CI: 2.02-6.09, p < .001).
- Symptomatic intracranial hemorrhage was more frequent with EVT, but the difference was not statistically significant (OR: 2.24, 95% CI: 0.84-5.94, p = .11).
Why it matters
Patients with pre-stroke disability are often excluded from large-vessel occlusion trials, leaving uncertainty about EVT outcomes in this group. These pooled findings suggest that survival and return to baseline function may be better with EVT, while the bleeding estimate remains imprecise. The results help frame the evidence gap but do not establish treatment effects with the certainty of prospective randomized evidence.
What to keep in mind
The analysis included only five studies, and the abstract does not identify them as randomized trials. Mortality results showed moderate heterogeneity (I 2 = 66.9%), and the sICH estimate was not statistically significant.