Efficacy and Safety of Endovascular Thrombectomy in Acute Ischemic Stroke Patients with ASPECTS ≤2: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: Acute ischemic stroke (AIS) affects approximately 11.9 million people annually, with large vessel occlusion (LVO) accounting for 10-20% of cases. While endovascular thrombectomy (EVT) is established for AIS with LVO, recent trials have expanded treatment to patients with Alberta Stroke Program Early CT Score (ASPECTS) 3-5. However, the efficacy and safety of EVT in patients with ASPECTS ≤2, representing extremely large infarcts with poor prognoses, remain uncertain due to limited evidence. This study evaluates EVT outcomes in this high-risk population. METHODS: PubMed, Embase, and Web of Science were searched (January 1, 2010-September 20, 2024) for studies comparing EVT plus best medical treatment (BMT) versus BMT alone in AIS patients with ASPECTS ≤2. Outcomes included favorable functional outcome (FFO, mRS 0-2), moderate functional outcome (MFO, mRS 0-3), modified Rankin Scale (mRS) shift, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and 90-day mortality. Unadjusted odds ratios (ORs) and risk differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic. RESULTS: Seven studies involving 718 patients (305 EVT, 413 BMT) were included. EVT significantly improved FFO (11.8% vs. 1.6%; OR 5.39, 95% CI: 2.06-14.13, p = 0.0002), MFO (24.2% vs. 11.5%; OR 2.50, 95% CI: 1.53-4.09, p = 0.0003), and mRS shift (OR 1.64, 95% CI: 1.30-2.06, p < 0.001). However, EVT increased sICH (16.5% vs. 2.4%; OR 5.30, 95% CI: 1.03-27.39, p < 0.001) and any ICH (40.7% vs. 14.9%; OR 3.91, 95% CI: 2.24-6.83, p < 0.001). No significant difference in 90-day mortality was observed (45.5% vs. 50.8%; OR 0.72, 95% CI: 0.34-1.53, p = 0.40), though EVT showed a trend toward reduced mortality. CONCLUSION: EVT significantly improves functional outcomes in AIS patients with ASPECTS ≤2; however, the absolute benefits remain modest, given the poor prognosis associated with large infarcts. While EVT increases hemorrhagic complications, it does not increase mortality and may provide meaningful benefits for carefully selected patients. Further large-scale trials are needed to refine EVT guidelines.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".