AUTHOR=Zhongxing Ye , Zhiqiang Liu , Jiangjie Wang , Qing Chen , Jinfeng Zhang , Chaoqun Weng , Feng Li 

TITLE=Efficacy and Safety of Endovascular Treatment for Acute Large-Vessel Ischemic Stroke Beyond 6 h After Symptom Onset: A Meta-Analysis

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.654816

DOI=10.3389/fneur.2021.654816

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> There is considerable evidence on the benefits of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) within 6 h after symptom onset. However, uncertainties remain regarding EVT efficacy beyond 6 h after symptom onset. We undertook a meta-analysis to assess the efficacy and safety of EVT in patients with AIS &gt;6 h after symptom onset.</p><p><bold>Methods:</bold> We searched PubMed, EMBASE, and Chinese Biomedical through July 2019. We included studies involving early (≤6 h) vs. delayed (&gt;6 h) EVT in selected patients with AIS, based on radiological evaluation criteria. Functional independence, successful recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) rates were assessed.</p><p><bold>Results:</bold> Eight articles, with 3,265 patients who had undergone early EVT and 1,078 patients who had received delayed EVT, were included in the meta-analysis. Patients treated with early EVT showed a similar proportion of functional independence at 90 days [odds ratio (OR) = 1.14, 95% confidence interval (CI) = 0.926–1.397, <italic>P</italic> = 0.219; <italic>I</italic><sup>2</sup> = 36.2%, <italic>P</italic> = 0.128] as those treated with delayed EVT. Delayed EVT was also associated with no significant difference in mortality (OR = 1.015, 95% CI = 0.852–1.209; <italic>P</italic> = 0.871; <italic>I</italic><sup>2</sup> = 0.0%, <italic>P</italic> = 0.527), successful recanalization (OR = 1.255, 95% CI = 0.923–1.705; <italic>P</italic> = 0.147; <italic>I</italic><sup>2</sup> = 60.5%, <italic>P</italic> = 0.009), and sICH (OR = 0.976, 95% CI = 0.737–1.293; <italic>P</italic> = 0.871; <italic>I</italic><sup>2</sup> = 0.0%, <italic>P</italic> = 0.742) rates compared with early EVT.</p><p><bold>Conclusions:</bold> Among selected patients with AIS, delayed EVT showed comparable outcomes in functional independence, recanalization, mortality, and sICH rates compared with early EVT.</p>