Systematic review and meta-analysis on EVT for anterior circulation LVO with low ASPECTS

BackgroundSeveral randomized controlled trials (RCTs) have shown endovascular thrombectomy (EVT) to be superior to standard medical care (MC) for anterior circulation large vessel occlusion (LVO)-related large ischemic infarcts at the 90-day follow-up, but long-term (≥90 days) safety and effectiveness evidence is lacking.ObjectivesThis meta-analysis used high-quality RCTs (1-year follow-up) to assess EVT’s clinical benefits in this patient group and compare short- vs. long-term prognostic changes.Search methodsLiterature searches were conducted in PubMed/MEDLINE, Scopus, and Web of Science from their inception to 28 September 2025 for RCTs comparing EVT and MC in acute anterior circulation ischemic stroke (AIS) with large ischemic infarcts. Study quality was evaluated using the Cochrane risk of bias tool.Selection criteriaThese included RCTs enrolled patients with confirmed anterior circulation LVO and low Alberta Stroke Program Early CT Score [ASPECTS] ≤ 5, compared EVT and MC, and reported long-term outcome data.Data collection and analysisA meta-analysis of long-term functional/safety outcomes was performed; subgroup analyses were performed based on onset time, ASPECTS, and imaging screening methods, along with leave-one-out sensitivity analysis.ResultsBaseline characteristics were balanced between the groups, and all included RCTs were high-quality. At long-term follow-up (>90 days to 12 months), EVT significantly improved functional excellence [modified Rankin Scale 0–1; risk ratio (RR) = 3.84, 95% confidence interval (CI) = 2.35–6.28; p