Risk of Early Recurrent Stroke and Thrombotic Events After Reperfusion Therapy in Acute Ischemic Stroke: A Meta-Analysis

BACKGROUND: Following an acute ischemic stroke, the risk of recurrent stroke is highest in the first 90 days. It is unclear whether this risk is altered by reperfusion therapy. In this meta-analysis, we aim to evaluate the risk of early recurrent stroke and other nonstroke thrombotic events postreperfusion therapy in acute ischemic stroke. METHODS: In this meta-analysis, randomized controlled trials (RCTs) were included in adults aged 18 years or older with acute ischemic stroke, comparing reperfusion treatment with best medical management (MED). We searched PUBMED, Embase, Cochrane Library, and Web of Science databases. The studies were grouped into endovascular thrombectomy (EVT) versus MED and intravenous thrombolysis versus MED. We performed a meta-analysis using a random-effects model (restricted maximum likelihood) to estimate the log risk ratio (RR) of early recurrent stroke and nonstroke thrombotic events (NSTE)-including myocardial infarction, acute coronary syndrome, deep vein thrombosis, pulmonary embolism, and peripheral embolism-after reperfusion therapy compared with MED at 90 days after symptom onset. This study is registered with PROSPERO (The International Prospective Register of Systematic Reviews). RESULTS: A total of 15 RCTs (n=4898) comparing EVT versus MED observed no difference in early recurrent stroke (5.5%, 143/2618 versus 4.5%, 102/2280; RR, 1.2 [95% CI, 0.9-1.6]). Nine RCTs (n=7193) comparing intravenous thrombolysis versus MED observed no difference in early recurrent stroke (2%, 73/3615 versus 1.8%, 66/3578; RR, 1.1 [95% CI, 0.8-1.5]). Fourteen RCTs (n=4033) comparing EVT versus MED reported NSTE. There was no difference in NSTE in the EVT arm (3.1%, 62/2024 versus 3.1%, 62/2009; RR, 1 [95% CI, 0.7-1.4]). Five RCTs (n=4961) comparing intravenous thrombolysis versus MED observed no difference in NSTE (2%, 51/2479 versus 2.2%, 54/2482; RR, 0.9 [95% CI, 0.6-1.4]). CONCLUSIONS: Reperfusion therapies (EVT±intravenous thrombolysis) in acute ischemic stroke within 24 hours of symptom onset were not associated with increased recurrent stroke or NSTE within 90 days compared with best medical therapy. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024542020.