Mechanical Thrombectomy for Mild Acute Ischemic Stroke with Large-Vessel Occlusion: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> The functional prognosis of mechanical thrombectomy (MT) for mild acute ischemic stroke (AIS) with large-vessel occlusion (LVO) is controversial. To explore a more precise estimation, a meta-analysis was conducted. <b><i>Methods:</i></b> The relevant studies were identified by searching PubMed, Embase, Web of Science, and Cochrane Collaboration Database until October 2021. The pooled analysis, subgroup analysis, sensitivity analysis, and publication bias examination were all conducted. The meta-analysis was performed by using Stata 12.0. <b><i>Results:</i></b> Eleven studies were included with a total of 1,929 subjects, including 794 patients receiving MT and 1,135 patients receiving medical management. The pooled analysis showed that MT might be not associated with functional prognosis among mild AIS with LVO (excellent functional prognosis: risk ratio (RR) = 1.07, 95% confidence interval (CI) = 0.94–1.21, <i>p</i> = 0.294; favorable functional prognosis: RR = 1.01, 95% CI = 0.96–1.06, <i>p</i> = 0.823). The statistical stability and reliability were demonstrated by the sensitivity analysis and publication bias outcomes. <b><i>Conclusion:</i></b> Our meta-analysis suggests that MT may be not associated with functional prognosis of mild AIS with LVO.

Endovascular treatment versus medical management for mild stroke with acute anterior circulation large vessel occlusion: a meta-analysis

“…In another meta-analysis that compared EVT and medical management in patient with AIS, baseline NIHSS scores ≤5, and LVO, EVT did not improve the functional outcomes among the patients 16. Similarly, an international multicenter study and meta-analysis documented no obvious difference in clinical outcomes between mechanical thrombectomy and medical management in patients with AIS and mild-deficit emergency LVO 31.…”

“…In contrast, Zhao et al reported similar functional outcomes after 3 months of EVT and medical treatment in patients with mild stroke (NIHSS score <5 or < 8) and LVO; furthermore, those who underwent EVT had an increased risk of symptomatic ICH 15. Another recent meta-analysis, which included only patients with baseline NIHSS scores ≤5, suggested that mechanical thrombectomy might not be related to the functional prognosis of patients with mild stroke and LVO 16. However, most of the aforementioned studies included patients with posterior circulation vessels and lacked propensity score (PS)-based methods to control confounding factors.…”

The non‐paretic‐hand‐to‐opposite‐ear test: A simple test to detect aphasia and neglect and an indicator of large anterior vessel occlusion in patients with suspected acute stroke

“…Overall, 8.6% of LAVO patients had no unilateral arm paresis, leading to false negative results. However, these patients were mostly mildly affected, making the decision for or against thrombectomy a matter of discussion (Hou et al, 2022 ).…”