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<p>Randomized controlled trials (RCTs) have demonstrated the efficacy of endovascular thrombectomy (EVT) in improving 3-month functional outcomes in patients with acute ischemic stroke due to large vessel occlusion. However, long-term outcome trajectories and health-related quality of life (HRQoL) beyond this 3-month period remain less clearly defined. We conducted a systematic review and meta-analysis of RCTs reporting outcomes beyond 90 days after EVT. Functional outcomes were assessed using the modified Rankin Scale (mRS) with favorable outcomes defined as mRS 0–2 for small-to-medium core trials and mRS 0–3 for large core or basilar artery occlusion trials. Mortality and HRQoL outcomes were also evaluated. Risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight RCTs including 3,014 patients (1,670 received EVT) with follow-up to 24 months were analyzed. EVT was associated with a favorable shift in mRS distribution (RR = 1.71, 95% CI 1.49–1.96) and higher rates of favorable outcomes (RR = 1.68, 95% CI 1.32–2.14). Patients with large core infarcts and basilar occlusion showed greater treatment gain with EVT beyond three months. EVT reduced long-term mortality (RR = 0.80, 95% CI 0.72–0.88), while rates of moderate-to-severe disability (mRS 3–5) were similar between groups. HRQoL (measured by the EQ-5D index) was significantly improved in the EVT group (SMD = 0.34, 95% CI 0.13–0.55). Our findings indicate that EVT provides sustained benefits beyond 3 months in functional outcomes, survival, and HRQoL. Recovery patterns in patients with large core infarcts or basilar occlusion seem to be more pronounced over longer periods.</p>

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Long-term outcome trajectories and health-related quality of life after endovascular thrombectomy for large vessel occlusion stroke: A meta-analysis of randomized trials

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Ahmed Alkhiri,
  • Fahad Alturki,
  • Hassan K. Salamatullah,
  • Hatoon Alshaikh,
  • Ahmed A. Almaghrabi,
  • Aser F. Alamri,
  • Basil A. Alghamdi,
  • Mishari S. Alqahtani,
  • Joseph P. Broderick,
  • Adel Alhazzani,
  • Fahad S. Al-Ajlan

摘要

Randomized controlled trials (RCTs) have demonstrated the efficacy of endovascular thrombectomy (EVT) in improving 3-month functional outcomes in patients with acute ischemic stroke due to large vessel occlusion. However, long-term outcome trajectories and health-related quality of life (HRQoL) beyond this 3-month period remain less clearly defined. We conducted a systematic review and meta-analysis of RCTs reporting outcomes beyond 90 days after EVT. Functional outcomes were assessed using the modified Rankin Scale (mRS) with favorable outcomes defined as mRS 0–2 for small-to-medium core trials and mRS 0–3 for large core or basilar artery occlusion trials. Mortality and HRQoL outcomes were also evaluated. Risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight RCTs including 3,014 patients (1,670 received EVT) with follow-up to 24 months were analyzed. EVT was associated with a favorable shift in mRS distribution (RR = 1.71, 95% CI 1.49–1.96) and higher rates of favorable outcomes (RR = 1.68, 95% CI 1.32–2.14). Patients with large core infarcts and basilar occlusion showed greater treatment gain with EVT beyond three months. EVT reduced long-term mortality (RR = 0.80, 95% CI 0.72–0.88), while rates of moderate-to-severe disability (mRS 3–5) were similar between groups. HRQoL (measured by the EQ-5D index) was significantly improved in the EVT group (SMD = 0.34, 95% CI 0.13–0.55). Our findings indicate that EVT provides sustained benefits beyond 3 months in functional outcomes, survival, and HRQoL. Recovery patterns in patients with large core infarcts or basilar occlusion seem to be more pronounced over longer periods.