Long-term (12 months) Outcomes of Endovascular Thrombectomy for Large Stroke: A Meta-Analysis of SELECT2, TESLA, TENSION, and LASTE trials

BACKGROUND: Endovascular thrombectomy (EVT) has demonstrated benefits over standard medical care (MC) in randomized controlled trials (RCTs) for patients with large vessel occlusion (LVO) and large infarct territory at 90 days. However, conflicting evidence exists regarding long-term safety and efficacy of EVT in these populations.

PURPOSE: To evaluate the clinical benefits of EVT in patients with large-core infarction through meta-analysis of high-quality RCT evidence with up to one-year follow-up.

DATA SOURCES: PubMed/MEDLINE, Web of Science, and Scopus databases.

STUDY SELECTION: RCTs involving patients with confirmed LVO and Alberta Stroke Program Early CT Score (ASPECTS) of ≤5, comparing EVT plus MC versus MC alone, with long-term outcome data.

DATA ANALYSIS: Meta-analysis of long-term functional and safety outcomes with subgroup analysis comparing long-term (≤1 year) versus short-term (≤90 days) data on functional outcomes, imaging modalities, and presentation window. Leave-one-out sensitivity analysis was performed to resolve heterogeneity.

DATA SYNTHESIS: Four RCTs comprising 1229 patients (49% female) were included. EVT demonstrated significant superiority over MC in functional independence (mRS0-2) (RR 3.91, 95% CI 2.7-5.66; P<0.001), mortality (RR 0.84, 95% CI 0.75-0.95; P=0.005), overall survival (mRS0-5) (RR 1.17, 95% CI 1.05-1.31; P=0.005), and quality of life (SMD 0.55, 95% CI 0.32-0.8; P<0.001) with up to one-year follow-up. No significant differences in complication rates were observed except for higher extra-cerebral thromboembolic events in the EVT group (RR 7.94, 95% CI 1.01-62.2; P=0.048).

LIMITATIONS: Study limited to RCT data with potential variations in thrombectomy techniques and patient selection criteria across trials.

CONCLUSIONS: In patients with ischemic stroke due to LVO with established large core infarct, EVT plus MC showed significant long-term benefits in functional outcomes, survival, and quality of life compared to MC alone.

ABBREVIATIONS: EVT = endovascular thrombectomy; MC = medical care; LVO = large vessel occlusion; ASPECTS = Alberta Stroke Program Early CT Score; RCTs = randomized controlled trials; RR = risk ratio; CI = confidence interval; SMD = standardized mean difference; mRS = modified Rankin Scale; sICH = symptomatic intracranial hemorrhage; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; HR = hazard ratio; ROB2 = Risk of Bias 2; NIHSS = National Institutes of Health Stroke Scale.