Abstract：
OBJECTIVE: The ideal management for ischemic stroke presenting in the very late time window, or beyond 24 hours from onset, is poorly understood. It is unknown if endovascular therapy (EVT) or best medical management (MM) is associated with superior clinical outcomes.
METHODS: A systematic literature and comparative meta-analysis was completed to evaluate the safety and efficacy of EVT vs. MM for stroke presenting beyond 24 hours. Outcome measures included: 90 day functional independence (mRS 0-2), 90 day mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. A random effects model was used for quantitative synthesis.
RESULTS: From the five included studies, a total of 704 patients were included with 461 treated with EVT and 243 treated with MM alone. The proportion of patients achieving functional independence was significantly higher in patients treated with EVT (34.6 %) compared to MM alone (15.9 %) (OR: 4.24; CI: 2.61-6.88, P < 0.00001; I2 =0 %). While sICH occurred more in EVT patients (6.8 %) compared to MM (2.8 %), this was not significant (OR: 1.96; CI: 0.61-6.27, P=0.26; I2 = 67 %). Lastly, 90 day morality occurred significantly less in the EVT group (24.5 %) compared to patients treated with MM (33.1 %), and with significantly lower odds (OR: 0.51; CI: 0.35-0.73, P=0.0003; I2=0 %).
CONCLUSIONS: In certain patients presenting beyond 24 hours with ischemic stroke, EVT is associated with a significantly higher odds of achieving functional independence and lower odds of mortality compared with MM. While these results do not function as proof, they do encourage further research into extending the window beyond 24 hours for EVT. Randomized clinical trials are warranted to validate these findings.
METHODS: A systematic literature and comparative meta-analysis was completed to evaluate the safety and efficacy of EVT vs. MM for stroke presenting beyond 24 hours. Outcome measures included: 90 day functional independence (mRS 0-2), 90 day mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. A random effects model was used for quantitative synthesis.
RESULTS: From the five included studies, a total of 704 patients were included with 461 treated with EVT and 243 treated with MM alone. The proportion of patients achieving functional independence was significantly higher in patients treated with EVT (34.6 %) compared to MM alone (15.9 %) (OR: 4.24; CI: 2.61-6.88, P < 0.00001; I2 =0 %). While sICH occurred more in EVT patients (6.8 %) compared to MM (2.8 %), this was not significant (OR: 1.96; CI: 0.61-6.27, P=0.26; I2 = 67 %). Lastly, 90 day morality occurred significantly less in the EVT group (24.5 %) compared to patients treated with MM (33.1 %), and with significantly lower odds (OR: 0.51; CI: 0.35-0.73, P=0.0003; I2=0 %).
CONCLUSIONS: In certain patients presenting beyond 24 hours with ischemic stroke, EVT is associated with a significantly higher odds of achieving functional independence and lower odds of mortality compared with MM. While these results do not function as proof, they do encourage further research into extending the window beyond 24 hours for EVT. Randomized clinical trials are warranted to validate these findings.
摘要：
目的：在非常晚的时间窗内出现的缺血性卒中的理想管理，或者从发病开始超过24小时，知之甚少。尚不清楚血管内治疗（EVT）或最佳医疗管理（MM）是否与优异的临床结果相关。
方法：完成了系统文献和比较荟萃分析，以评估EVT与EVT的安全性和有效性。MM表示中风超过24小时。结果指标包括：90天功能独立性（mRS0-2），90天死亡率，和症状性颅内出血（sICH）的发生。随机效应模型用于定量合成。
结果：从纳入的五项研究中，共纳入704例患者,其中461例接受EVT治疗,243例仅接受MM治疗.使用EVT治疗的患者实现功能独立性的比例（34.6％）明显高于单独使用MM（15.9％）（OR：4.24；CI：2.61-6.88，P<0.00001；I2=0％）。虽然与MM（2.8％）相比，EVT患者的sICH发生率更高（6.8％），这并不显著(OR:1.96;CI:0.61-6.27,P=0.26;I2=67%)。最后,与接受MM治疗的患者（33.1％）相比，EVT组（24.5％）的90天道德发生率显着降低，并且赔率显着降低（OR：0.51；CI：0.35-0.73，P=0.0003；I2=0%）。
结论：在某些超过24小时的缺血性卒中患者中，与MM相比，EVT与实现功能独立性的几率显着升高和死亡率降低相关。虽然这些结果不能作为证据，他们确实鼓励进一步研究将EVT的窗口延长到24小时以上。有必要进行随机临床试验来验证这些发现。
方法：完成了系统文献和比较荟萃分析，以评估EVT与EVT的安全性和有效性。MM表示中风超过24小时。结果指标包括：90天功能独立性（mRS0-2），90天死亡率，和症状性颅内出血（sICH）的发生。随机效应模型用于定量合成。
结果：从纳入的五项研究中，共纳入704例患者,其中461例接受EVT治疗,243例仅接受MM治疗.使用EVT治疗的患者实现功能独立性的比例（34.6％）明显高于单独使用MM（15.9％）（OR：4.24；CI：2.61-6.88，P<0.00001；I2=0％）。虽然与MM（2.8％）相比，EVT患者的sICH发生率更高（6.8％），这并不显著(OR:1.96;CI:0.61-6.27,P=0.26;I2=67%)。最后,与接受MM治疗的患者（33.1％）相比，EVT组（24.5％）的90天道德发生率显着降低，并且赔率显着降低（OR：0.51；CI：0.35-0.73，P=0.0003；I2=0%）。
结论：在某些超过24小时的缺血性卒中患者中，与MM相比，EVT与实现功能独立性的几率显着升高和死亡率降低相关。虽然这些结果不能作为证据，他们确实鼓励进一步研究将EVT的窗口延长到24小时以上。有必要进行随机临床试验来验证这些发现。
