Abstract：
Endovascular Thrombectomy (EVT) as first-line treatment of patients with large core ischemic infarct is a subject of debate. A systematic literature search was conducted in four electronic databases for randomized control trials (RCTs) comparing EVT to best medical treatment (BMT) for large core infarcts (ASPECTS ≤ 5). Relevant studies were added after screening for titles, abstracts, and complete text. Meta-analysis was performed. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95% CI, while the binary outcomes were analyzed using the risk ratio (RR) and 95% confidence interval (CI). A funnel plot was used to visually evaluate publication bias, and if feasible, Egger\'s test was used to validate. We included 1918 patients from six RCTs that compared EVT plus BMT and BMT alone in patients with large core infarct due to large vessel occlusion in the anterior circulation. There were 946 patients in the EVT group and 972 patients in the BMT group. The one-year outcomes are available for 314 patients in the EVT group and 292 patents in the BMT group from two RCTs. EVT group had statistically significant higher rate of 90-day mRS 0-1 (RR = 3.1, P-value < 0.0001), mRS 0-2 (RR = 2.64, P-value < 0.0001), mRS 0-3 (RR = 1.80, P-value < 0.0001), lower 90-day mean mRS score (SMD = -0.29, P-value < 0.0001), lower 90-day mortality rate (RR = 0.85, P-value = 0.015), and greater early neurological improvement (RR = 2.16, P-value < 0.00001) compared to the BMT group. However, the rates of symptomatic intracerebral hemorrhage (sICH) (RR = 1.76, P-value = 0.01) and any ICH (RR = 2.18, P-value < 0.00001) were higher in EVT group. Our finding showed that EVT plus BMT led to in an absolute improvement of 5%, 12%, and 16% in 90-day mRS 0-1, 0-2, and 0-3, respectively. In addition, patients in EVT plus BMT group had a 3% increased probability of experiencing sICH and were 32% more susceptible to any ICH. Moreover, the one-year mRS 0-2 (RR = 2.16, P-value < 0.00001) and mRS 0-3 (RR = 1.80, P-value < 0.0001) was significantly favor the EVT plus BMT over BMT alone. Although, the one-year mortality rate was not significantly differed between two groups (RR = 0.91, P-value = 0.31). There was no statistically significant difference observed between the EVT plus BMT group and the BMT group concerning new stroke, decompressive craniectomy, and serious adverse events. Combined data from six RCTs shows that EVT plus BMT provides significantly better short- and long-term functional outcomes with minimal increase in symptomatic hemorrhage over BMT in patient with large core infarcts.
摘要：
血管内血栓切除术（EVT）作为大核心缺血性梗死患者的一线治疗是一个有争议的话题。在四个电子数据库中进行了系统的文献检索，用于比较EVT与大型核心梗塞（ASPECTS≤5）的最佳药物治疗（BMT）的随机对照试验（RCT）。筛选标题后增加了相关研究，摘要,和完整的文本。进行Meta分析。使用标准化均差（SMD）和95％CI分析连续结果，而使用风险比（RR）和95％置信区间（CI）分析二元结果。漏斗图用于直观评估出版偏倚，如果可行的话,Egger\的测试用于验证。我们纳入了来自六个RCT的1918例患者，这些患者比较了由于前循环大血管闭塞而导致大核心梗塞的患者的EVT加BMT和单独BMT。EVT组946例，BMT组972例。来自两个RCTs的EVT组的314名患者和BMT组的292名患者可获得一年的结果。EVT组90天mRS0-1的发生率有统计学意义（RR=3.1，P值<0.0001），mRS0-2（RR=2.64，P值<0.0001），mRS0-3（RR=1.80，P值<0.0001），90天平均mRS评分较低（SMD=-0.29，P值<0.0001），90天死亡率较低（RR=0.85，P值=0.015），与BMT组相比，早期神经系统改善更大（RR=2.16，P值<0.00001）。然而,EVT组症状性脑出血(sICH)(RR=1.76,P值=0.01)和任何ICH(RR=2.18,P值<0.00001)的发生率较高.我们的发现表明，EVT加BMT导致5%的绝对改善，12%,90天mRS0-1、0-2和0-3分别为16%。此外,EVT+BMT组患者发生sICH的概率增加3%,发生任何ICH的易感性增加32%.此外，一年期mRS0-2(RR=2.16,P值<0.00001)和mRS0-3(RR=1.80,P值<0.0001)明显优于单纯BMT。虽然,两组的1年死亡率无显著差异(RR=0.91,P值=0.31).EVT加BMT组与BMT组的新卒中差异无统计学意义。去骨瓣减压术,和严重不良事件。来自六个RCT的综合数据表明，EVT加BMT提供了明显更好的短期和长期功能结果，并且在大核心梗死患者中，症状性出血的增加最小。
