BACKGROUND AND PURPOSE New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only. METHODS We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low-certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD -0.7%, 95% CI -3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI -0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only. CONCLUSION Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.

中文翻译：

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大面积缺血性中风的血管内血栓切除术：随机试验的实时系统回顾和荟萃分析。

背景和目的 新的研究表明，血管内血栓切除术 (EVT) 对大面积缺血区域的急性缺血性卒中 (AIS) 患者安全有效。我们研究的目的是对比较 EVT 与仅医疗管理的随机试验进行实时系统回顾和荟萃分析。方法 我们搜索了 MEDLINE、Embase 和 Cochrane 图书馆，以确定在大面积缺血区域的 AIS 患者中比较 EVT 与单独药物治疗的随机对照试验 (RCT)。我们使用固定效应模型进行了荟萃分析，以比较 EVT 和仅标准医疗管理之间的功能独立性、死亡率和症状性颅内出血 (sICH)。我们使用 Cochrane 偏倚风险工具评估了偏倚风险，并使用建议分级、评估、开发和评价方法评估了每个结果的证据的确定性。结果 在 14,513 篇引用中，我们纳入了 3 项随机对照试验，共有 1,010 名参与者。我们发现低质量证据表明功能独立的患者比例可能大幅增加（风险差异 [RD] 30.3%，95% CI 15.0% 至 52.3%），低质量证据表明可能有小的非显着下降死亡率（RD -0.7%，95% CI -3.8% 至 3.5%），低质量证据表明 sICH 可能有小幅非显着增加（RD 3.1%，95% CI -0.3% 至 9.8%）与仅接受药物治疗相比，接受 EVT 的大面积梗死 AIS 患者。