The Safety and Efficacy of Endovascular Treatment for Patients With ASPECTS6 in Anterior Circulation Stroke: A Meta-Analysis and Subgroup Analysis by Imaging Techniques

Endovascular treatment (EVT) is merely recommended as class of recommendation IIb for patients with ASPECTS6 according to the American Heart Association guideline 2019. In addition, the best determined imaging technique for EVT in patient with ASPECTS6 remains unknown. The objective of this study was to define the safety and efficacy of EVT for patients with ASPECTS6 and investigate the superiority between MRI and CT for patient selection.A systematic search of PubMed, EMBASE, The Cochrane Library and other additional sources was performed for studies published with no publication period. Our study was conducted corresponding to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRIMA) guidelines. The analysis was performed using the Comprehensive Meta-Analysis (CMA) 2.0.Five studies reporting data from 844 participants were included in our analysis according to the inclusion criteria. Consequently, EVT was associated with statistically significant higher functional independence compared with MT (OR 5.401, 95% CI 3.227-9.041). Whereas EVT was found to be related to lower mortality compared with MT based on eligible data (OR 0.461, 95% CI 0.329-0.647). No significant difference was identified in sICH between EVT and MT (OR 1.075, 95% CI 0.452-2.558).According to the results of our study, we suggested that EVT is a preferred therapy in ACS patients with ASPECTS6 in consideration of efficacy and safety. Furthermore, MRI did not show superiority over CT as no statistical difference was detected in all subgroups.