Long-Term Outcomes of Endovascular Treatment versus Best Medical Treatment in Patients with Large-Vessel Occlusion Stroke: A Meta-Analysis

INTRODUCTION: For patients with acute ischaemic stroke caused by large vessel occlusion (LVO), there is limited evidence regarding the long-term outcomes of endovascular treatment (EVT) compared with best medical treatment (BMT). The objective of this study was to evaluate the long-term efficacy and safety of EVT in LVO stroke patients. METHODS: This study systematically searched electronic databases from January 2015 to August 2024 and included seven eligible trials. These studies reported 1-2 year of follow-up data on functional independence (modified Rankin Scale [mRS] score 0-2), distribution of mRS on shift analysis, quality of life (European Quality of Life 5-Dimensions Questionnaire score), and mortality. RESULTS: A total of 1,236 patients who received EVT and 1,122 who received BMT were included in the analysis. Compared with BMT, EVT was associated with a significantly greater likelihood of functional independence (odds ratio [OR] 2.55, 95% confidence interval [CI], 1.76-3.70), improved distribution of mRS scores on shift analysis (common OR 1.67, 95% CI, 1.37-2.02), and a better quality of life (beta coefficient 0.13, 95% CI, 0.07-0.19) at 1-2 years of follow-up. Compared with BMT, EVT was also associated with lower rates of all-cause mortality (OR 0.67, 95% CI, 0.56-0.81). Compared with 90-day follow-up, long-term follow-up demonstrated an improvement in functional independence among LVO stroke patients (1.7% vs. 0.2%), whereas the increase in mortality was slower (9.3% vs. 11.3%). CONCLUSIONS: This meta-analysis indicated that LVO stroke patients can achieve long-term benefits following EVT. The findings provide valuable evidence to inform clinical decision-making.