Long-Term (12 Months) Outcomes of Endovascular Thrombectomy for Large Core Stroke: A Meta‐Analysis of SELECT2, TESLA, TENSION, and LASTE Trials
Bibliographic record
Abstract
ABSTRACT BACKGROUND: Endovascular thrombectomy (EVT) has demonstrated benefits over standard medical care (MC) in randomized controlled trials (RCTs) for patients with large vessel occlusion (LVO) and large infarct territory at 90 days. However, conflicting evidence exists regarding long-term safety and efficacy of EVT in these populations. PURPOSE: To evaluate the clinical benefits of EVT in patients with large-core infarction through meta-analysis of high-quality RCT evidence with up to one-year follow-up. DATA SOURCES: PubMed/MEDLINE, Web of Science, and Scopus databases. STUDY SELECTION: RCTs involving patients with confirmed LVO and Alberta Stroke Program Early CT Score (ASPECTS) of ≤5, comparing EVT plus MC versus MC alone, with long-term outcome data. DATA ANALYSIS: Meta-analysis of long-term functional and safety outcomes with subgroup analysis comparing long-term (≤1 year) versus short-term (≤90 days) data on functional outcomes, imaging modalities, and presentation window. Leave-one-out sensitivity analysis was performed to resolve heterogeneity. DATA SYNTHESIS: Four RCTs comprising 1229 patients (49% female) were included. EVT demonstrated significant superiority over MC in functional independence (mRS0-2) (RR 3.91, 95% CI 2.7-5.66; P<0.001), mortality (RR 0.84, 95% CI 0.75-0.95; P=0.005), overall survival (mRS0-5) (RR 1.17, 95% CI 1.05-1.31; P=0.005), and quality of life (SMD 0.55, 95% CI 0.32-0.8; P<0.001) with up to one-year follow-up. No significant differences in complication rates were observed except for higher extra-cerebral thromboembolic events in the EVT group (RR 7.94, 95% CI 1.01-62.2; P=0.048). LIMITATIONS: Study limited to RCT data with potential variations in thrombectomy techniques and patient selection criteria across trials. CONCLUSIONS: In patients with ischemic stroke due to LVO with established large core infarct, EVT plus MC showed significant long-term benefits in functional outcomes, survival, and quality of life compared to MC alone. ABBREVIATIONS: EVT = endovascular thrombectomy; MC = medical care; LVO = large vessel occlusion; ASPECTS = Alberta Stroke Program Early CT Score; RCTs = randomized controlled trials; RR = risk ratio; CI = confidence interval; SMD = standardized mean difference; mRS = modified Rankin Scale; sICH = symptomatic intracranial hemorrhage; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; HR = hazard ratio; ROB2 = Risk of Bias 2; NIHSS = National Institutes of Health Stroke Scale.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.022 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.052 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".