Long-term efficacy and safety of endovascular thrombectomy for acute ischemic stroke with large vessel occlusion: a systematic review and meta-analysis.

Background: Endovascular thrombectomy (EVT) improves functional outcomes at 90 days in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, its long-term efficacy and safety beyond 90 days remain unclear. Objective: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EVT plus best medical treatment (BMT) versus BMT alone beyond 90 days in patients with AIS and LVO. Methods: PubMed, Embase, and Cochrane Central databases were searched to identify randomized controlled trials (RCTs) comparing EVT plus BMT versus BMT alone in AIS patients with LVO. Primary outcomes included functional independence (mRS ≤2), independent ambulation (mRS ≤3), death or dependency (mRS 4-6), and all-cause mortality beyond 90 days. We applied a random-effects model and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) using the Cochrane RoB2 tool for assessing risk of bias in randomized trials. Results: Seven RCTs with 2358 patients (56% males) were included. The mean age of the patients was 69.5 years and mean follow-up duration was 1.2 years. The results showed that EVT combined with BMT improved functional independence (mRS ≤2) (RR 2.08, CI: 1.55-2.80; P < 0.00001), independent ambulation (mRS ≤3) (RR 1.71, CI: 1.36-2.15; P < 0.00001), and quality of life (SMD 0.36; CI: 0.19-0.54; P < 0.00001) beyond 90 days compared to BMT alone. Moreover, the EVT plus BMT group also had a significantly reduced death or dependency (mRS 4-6) (RR 0.78, CI: 0.73-0.84; P < 0.00001) and all-cause mortality (RR 0.83, CI: 0.76-0.90; P < 0.0001) beyond 90 days than the BMT group. All RCTs were rated as having a low risk of bias. Conclusion: EVT combined with BMT significantly improves long-term functional outcomes and quality of life and reduces mortality in AIS patients with LVO compared to BMT alone.