Abstract
Background and Purpose
Methods
Results
Supplementary materials
Supplementary Table 1.
Supplementary Table 2.
Supplementary Figure 1.
Supplementary Figure 2.
Notes
Conflicts of interest
The authors completed the ICMJE Disclosure Forms and declare no competing interests.
Author contribution
Conceptualization: RZM, ME, FA, TK. Study design: RZM, ME, HSG. Methodology: RZM, ME, HSG. Data collection: RZM, ME, HSG, MA, AE, SK, HD. Investigation: all authors. Statistical analysis: RZM, HSG. Writing—original draft: RZM, ME, HSG. Writing— review & editing: all authors. Approval of final manuscript: all authors.
References
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Figure 1.
![jos-2023-00752f1.tif](/upload/SynapseXML/1183jos/thumb/jos-2023-00752f1.gif)
Figure 2.
![jos-2023-00752f2.tif](/upload/SynapseXML/1183jos/thumb/jos-2023-00752f2.gif)
Figure 3.
![jos-2023-00752f3.tif](/upload/SynapseXML/1183jos/thumb/jos-2023-00752f3.gif)
Figure 4.
![jos-2023-00752f4.tif](/upload/SynapseXML/1183jos/thumb/jos-2023-00752f4.gif)
Table 1.
Study ID | Country | Study timeframe | Study design | Sample size (n) | Age, y (mean, SD) | Male (%) | History of stroke (%) | History of atrial fibrillation (%) | History of diabetes (%) | History of hypertension (%) | Initial NIHSS (mean, SD) | Initial ASPECTS (mean, SD) | Infarct core volume, mL (mean, SD) | ICA occlusion (%) | M1 MCA occlusion (%) | M2 MCA occlusion (%) | Tandem occlusion (%) | Intravenous thrombolysis (%) | Type and dose of thrombolytic agent used |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Huo 2023 [7] [ANGEL- ASPECT] | China | October 2, 2020–May 18, 2022 | RCT | 455 | 66.84 (9.72) | 61.32 | 16.04 | 22.86 | 18.24 | 59.78 | 16 (5) | 3 (1) | 59.24 (41.76) | 36.04 | 63.08 | 0.88 | 16.70 | 28.35 | Alteplase 0.9 mg/kg; urokinase 1.0 to 1.5 million IU |
Sarraj 2023 [8] [SELECT-2] | International | September 2019–September 2022 | RCT | 352 | 66.50 (12.69) | 58.81 | 9.09 | 24.15 | 30.68 | 73.86 | 19 (6) | 4 (1) | 84.76 (41.35) | 41.48 | 54.26 | 4.26 | 28.41 | 19.09 | Alteplase NOS; tenecteplase NOS |
Yoshimura 2022 [9] [RESCUE-Japan LIMIT] | Japan | November 2018–September 2021 | RCT | 203 | 76.15 (10.09) | 55.67 | 25.12 | 59.11 | 21.18 | 69.46 | 22 (6) | 4 (1) | 106.01 (57.50) | 47.29 | 70.94 | 1.48 | 19.70 | 27.59 | Alteplase 0.6 mg/kg |
SD, standard deviation; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; ICA, internal carotid artery; MCA, middle cerebral artery; RCT, randomized controlled trial; IU, international unit; NOS, not otherwise specified; ANGEL-ASPECT, Study of Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core; SELECT-2, A Randomized Controlled Trial to Optimize Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke; RESCUE-Japan LIMIT, Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Large IscheMIc core Trial.
Table 2.
Outcomes of all RCTs [7-9] |
Certainty assessment |
No. of patients |
Effect |
Certainty | Importance | |||||
---|---|---|---|---|---|---|---|---|---|---|
Inconsistency | Indirectness | Imprecision | Endovascular therapy | Medical management only | RR (95% CI) | Baseline risk for control group (%)* | RD (%) (95% CI) | |||
Functional independence at 90 days | Not serious | Not serious | Very serious† | 119/507 (23.5%) | 46/498 (9.2%) | 2.53 (1.76 to 3.64) | 19.8 | 30.3 (15.0 to 52.3) | ⊕⊕◯◯ | CRITICAL |
Low | ||||||||||
Mortality at 90 days | Not serious | Not serious | Very serious† | 136/507 (26.8%) | 140/498 (28.1%) | 0.95 (0.73 to 1.25) | 14.0 | -0.7 (-3.8 to 3.5) | ⊕⊕◯◯ | CRITICAL |
Low | ||||||||||
Symptomatic intracranial hemorrhage | Not serious | Not serious | Very serious† | 24/508 (4.7%) | 13/501 (2.6%) | 1.83 (0.92 to 3.64) | 3.7 | 3.1 (-0.3 to 9.8) | ⊕⊕◯◯ | IMPORTANT |
Low |
GRADE, Grading of Recommendations, Assessment, Development, and Evaluations; RCTs, randomized controlled trials; EVT, endovascular thrombectomy; RR, risk ratio; CI, confidence interval; RD, risk difference.