Background and purpose

At present, endovascular thrombectomy (EVT) has been gradually became a standard therapy for stroke patients caused by emergent large-vessel occlusion (ELVO). However, the question about whether EVT is superior to medical treatment for mild stroke patients presenting with a low baseline National Institutes of Health Stroke Scale (NIHSS) score remains unclear. The aim of this systematic review and meta-analysis was to compare the safety and efficacy of EVT with medical treatment in mild stroke patients.

Material and methods

A systematic review and meta-analysis was conducted through searching the PubMed, Embase and Cochrane Library databases. All statistical analyses were performed by using Review Manager 5.3 software. Primary outcomes of this meta-analysis were as follows: favorable functional outcome at 90 days (defined as a modified Rankin scale (mRS) score of 0–2); excellent functional outcome at 90 days (defined as a mRS score of 0–1); symptomatic intracerebral hemorrhage (sICH); mortality at 90 days.

Results

A total of 13 eligible studies with 2135 patients were included in this meta-analysis. The pooled results indicated that mild stroke patients underwent EVT had higher risk of sICH than those receiving medical treatment alone (OR = 3.21; 95% CI, 1.98–5.22; P < 0.001). In addition, no significant difference was found between the two groups in mortality at 90 days (OR = 1.80; 95% CI, 0.88–3.65; P=0.11). Meanwhile, no significant difference was found between the two groups in patients achieving favorable functional outcome at 90 days and excellent functional outcome at 90 days (OR = 1.10; 95% CI, 0.74–1.64; P = 0.65) (OR = 1.03; 95% CI, 0.79–1.35; P = 0.80).

Conclusions

Our pooled results showed similar clinical outcomes at 90 days of EVT and medical treatment in mild stroke patients with ELVO, although patients underwent EVT had higher rates of sICH. However, due to several limitations of this meta-analysis, randomized controlled trials are needed to further evaluate the potential efficacy of EVT in mild stroke patients.

中文翻译：

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血管内血栓切除术VS。轻度卒中患者的药物治疗：系统评价和荟萃分析

背景和目的

目前，血管内血栓切除术（EVT）已逐渐成为由急诊大血管闭塞（ELVO）引起的中风患者的标准疗法。但是，对于基线水平较低的美国国立卫生研究院卒中量表（NIHSS）得分较低的轻度卒中患者，EVT是否优于药物治疗尚无定论。该系统评价和荟萃分析的目的是比较EVT与轻度中风患者药物治疗的安全性和有效性。

材料与方法

通过搜索PubMed，Embase和Cochrane图书馆数据库进行了系统的综述和荟萃分析。所有统计分析均使用Review Manager 5.3软件进行。这项荟萃分析的主要结果如下：90天的良好功能结果（定义为改良的Rankin量表（mRS）评分为0–2）；在90天时具有出色的功能结局（mRS评分为0-1）；症状性脑出血（sICH）；90天死亡率。

结果

这项荟萃分析共纳入13项合格研究，涉及2135例患者。汇总结果表明，接受单独EVT的轻度卒中患者发生sICH的风险高于仅接受药物治疗的患者（OR = 3.21； 95％CI，1.95-5.22； P <0.001）。此外，两组在90天时的死亡率无显着差异（OR = 1.80； 95％CI，0.88–3.65； P = 0.11）。同时，两组患者在90天时获得良好的功能结局和90天时具有出色的功能结局（OR = 1.10; 95％CI，0.74–1.64; P = 0.65）（OR = 1.03; 95），两组之间无显着差异。 ％CI，0.79–1.35； P = 0.80）。

结论

我们的汇总结果显示，尽管接受EVT的患者发生sICH的发生率较高，但轻度卒中的ELVO患者在90天EVT和药物治疗后的临床结局相似。但是，由于该荟萃分析的几个局限性，需要进行随机对照试验来进一步评估EVT在轻度中风患者中的潜在疗效。