Abstract TP48: Mechanical Thrombectomy for Large Vessel Occlusion in Acute Ischemic Stroke Patients Presenting After 6 hours of Symptom Onset—A Meta-analysis of Randomized Controlled Clinical Trials

Abstract

Background: The efficacy and safety of endovascular treatment for proximal large vessel occlusion after 6 hours of symptom onset have recently been studied in randomized controlled trials. We performed this meta-analysis to identify the combined effect of endovascular treatment on various outcomes in this patient population. Methods: We performed this meta-analysis of all available randomized controlled clinical studies that involved the use of endovascular treatment in after 6 hours of symptom onset. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using random-effects models. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days post-randomization. Other outcome variables included symptomatic intracerebral hemorrhage, excellent outcome (mRS 0-1), and mortality at 90 days post-randomization. Results: Three trials were identified that included 447 patients. The proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (445 subjects analyzed; OR 4.34; 95% CI, 2.65-7.14; P < .001). Excellent outcome was also significantly greater among those randomized to endovascular treatment (445 subjects analyzed; odds ratio, 3.29; 95% CI, 1.98-5.46, P < .001). Risk of symptomatic intracranial hemorrhage and mortality were similar between endovascular treatment and best medical treatment with p-value of 0.320 and 0.375, respectively. No risk of heterogeneity was observed in any of outcome variables. Conclusion: We found a prominent benefit (4 times higher odds) with endovascular treatment in appropriately selected patients with large vessel occlusion ischemic stroke presenting after 6 hours of symptom onset