Recent studies indicate endovascular thrombectomy (EVT) as a safe, effective treatment for acute ischemic stroke (AIS) with large ischemic regions. Our study updates an ongoing living systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of EVT to medical management only. We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing EVT to medical management in AIS patients with large ischemic areas. Using fixed-effect models, we conducted a meta-analysis to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management. We evaluated bias risk with the Cochrane tool and graded the certainty of evidence using the GRADE approach. Of 1363 new citations, we included six RCTs with a total of 1876 patients. We found low-certainty evidence of improved functional independence (risk difference [RD] 29.9%, 95% CI 17.2% to 46.9%), increase in sICH (RD 2.6%, 95% CI 0.3% to 6.4%), and a non-significant decrease in mortality (RD -1.8%, 95% CI -3.9% to 0.6%) for AIS patients with large infarcts who underwent EVT compared to medical management only. Our revised meta-analysis suggests low-certainty evidence that there is improved functional independence, a non-significant decrease in mortality, and an increase in sICH among AIS patients with large infarcts who undergo EVT compared to those receiving medical management alone. PROSPERO (CRD42023398742).

中文翻译：

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血管内血栓切除术治疗大面积缺血性中风：随机临床试验的最新动态系统评价和荟萃分析

最近的研究表明，血管内血栓切除术（EVT）是治疗大面积缺血性急性缺血性卒中（AIS）的一种安全有效的方法。我们的研究更新了正在进行的随机对照试验（RCT）的实时系统评价和荟萃分析，仅比较 EVT 与医疗管理的结果。我们检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，以查找比较 EVT 与大面积缺血 AIS 患者药物治疗的随机对照试验。我们使用固定效应模型进行荟萃分析，以比较 EVT 和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 工具评估偏倚风险，并使用 GRADE 方法对证据的确定性进行分级。在 1363 个新引用中，我们纳入了 6 项随机对照试验，总共 1876 名患者。我们发现了功能独立性改善的低质量证据（风险差异 [RD] 29.9%，95% CI 17.2% 至 46.9%），sICH 增加（RD 2.6%，95% CI 0.3% 至 6.4%），并且非-与仅进行药物治疗相比，接受 EVT 的大面积梗死 AIS 患者的死亡率显着降低（RD -1.8%，95% CI -3.9% 至 0.6%）。我们修订后的荟萃分析表明，低质量证据表明，与仅接受药物治疗的患者相比，接受 EVT 治疗的大面积梗死 AIS 患者的功能独立性得到改善，死亡率没有显着降低，并且 sICH 增加。普洛斯彼罗 (CRD42023398742)。