Question and Methods: This systematic review & meta-analysis attempts to answer the question of whether endovascular therapy is a suitable intervention for anterior circulation large vessel occlusion strokes presenting beyond 6h from time last seen well by analyzing individual patient data pooled from 6 RCTs.
Findings: Thrombectomy is associated with higher rates of independence (mRS 0-2) than medical therapy alone (OR 2.54 (adjusted), p-value < 0.0001) but there was no significant difference when analyzing 90d mortality or intracerebral hemorrhage.
Limitations: Methodological quality of this study is lacking.
Interpretation: This study confirms that thrombectomy is beneficial for large vessel anterior circulation strokes presenting 6-24h from time last seen well but does not change current practice.
By: Dr. Evelyn Tran
JC Supervisor: Dr. Jeff Perry
Dr. Evelyn Tran is an Emergency Medicine resident at the University of Ottawa, Department of Emergency Medicine.
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
Dr. Perry is an Emergency Physician and full Professor in the department of Epidemiology and Community Medicine. He has a special research interest in subarachnoid hemorrhage, TIA and stroke.