Thrombectomy for the Treatment of Large Core Ischemic Strokes: An Updated Systematic Review and Meta-analysis After the Release of the TESLA and TENSION Trials (P9-5.001)

OBJECTIVE: This study aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) in large-core acute ischemic stroke (AIS) patients. BACKGROUND: The available evidence supporting the use of EVT in patients with large-core AIS is increasing. Recently, the results of the TESLA and TENSION trials were released. This calls for an updated systematic review and meta-analysis that combines these studies with the prior results of previously published trials. DESIGN/METHODS: A systematic review was conducted to include randomized controlled trials (RCTs) that compared EVT to medical management (MM) for the treatment of patients with large-core AIS. The outcomes included the modified Rankin Scale (mRS) and mortality at 90 days and rates of symptomatic intracranial hemorrhage (sICH). An mRS of 0-2 and 0-3 were used to define independent and moderate functional status, respectively. Pooled odds ratios (OR) were calculated for shift mRS through the random-effects meta-analyses, while risk ratios (RR) were used for the other outcomes, comparing EVT with MM alone. RESULTS: Out of 2105 documents from title and abstract screening, this study included five RCTs. The odds for a shift to better mRS was higher in the EVT group as compared to the MM alone (OR: 1.46, 95%CI: 1.19-1.79). Furthermore, the use of EVT was associated with more instances of independent (RR: 2.47, 95%CI: 1.87-3.25) and moderate (RR: 1.77, 95%CI: 1.41-2.24) functional status as compared to MM. The rates of sICH were higher in the EVT group (RR: 1.73, 95%CI: 1.01-2.95) than the MM, but there was no difference between the two groups regarding mortality (RR: 0.92, 95%CI: 0.8-1.06). Subgroup analyses based on age, location, window, NIHSS, ASPECTS, core-volume, thrombolysis, and etiology did not yield group differences. CONCLUSIONS: Mr. Dibas has nothing to disclose. Dr. Almajali has nothing to disclose. Dr. Ghannam has nothing to disclose. Dr. Galecio-Castillo has nothing to disclose. Abdullah Al Qudah has nothing to disclose. Dr. Khasiyev has nothing to disclose. Mr. Vivanco-Suarez has nothing to disclose. Dr. Rodriguez-Calienes has nothing to disclose. Dr. Shogren has nothing to disclose. Dr. Al Majali has nothing to disclose. Dr. Yoo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Penumbra. Dr. Yoo has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Yoo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Philips. Dr. Yoo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Yoo has stock in Insera Therapeutics. Dr. Yoo has stock in Galaxy Therapeutics. Dr. Yoo has stock in Nicolab. The institution of Dr. Yoo has received research support from Medtronic. The institution of Dr. Yoo has received research support from Cerenovus. The institution of Dr. Yoo has received research support from Penumbra. The institution of Dr. Yoo has received research support from Stryker. The institution of Dr. Yoo has received research support from Genentech. Dr. Yoo has a non-compensated relationship as a consultant with Vesalio that is relevant to AAN interests or activities. Dr. Yoo has a non-compensated relationship as a consultant with Zoll Circulation that is relevant to AAN interests or activities. Dr. Samaniego has nothing to disclose. Dr. Sarraj has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker Neurovascular. Dr. Sarraj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Stryker Neurovascular. The institution of Dr. Sarraj has received research support from Stryker Neurovascular. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from IschemiaView. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.