The Efficacy and Safety of Endovascular Treatment on Large Vessel Occlusion of Intracranial Atherosclerosis Versus Embolism: A Meta-Analysis

This study is to assess the efficacy and safety of endovascular treatment for acute ischemic stroke resulting from intracranial atherosclerosis-large vessel occlusion (ICAS-LVO) in comparison to embolic-large vessel occlusion (embolic-LVO). We undertook an extensive search of databases including PubMed, Embase, The Cochrane Library, Wanfang Data, and China National Knowledge Internet using a combination of free-text terms and mesh terms as part of our search strategy. Literature screening and data retrieval were conducted following predefined inclusion/exclusion criteria. The search timeframe was limited to studies published until August 2021. All statistical evaluations were carried out by Review Manager 5.3. This meta-analysis comprised a total of 2748 patients across 14 studies. Our results demonstrate a significantly lower rate of systematic intracranial hemorrhage in ICAS-LVO compared with embolic-LVO following endovascular therapy. Moreover, the rates of rescue therapy and stent implantation were significantly lower in ICAS-LVO versus embolic-LVO. However, the 2 groups had a similar recanalization rate, favorable outcome, and mortality rates at 90 days post endovascular treatment. Patients with ICAS-LVO exhibit a lower incidence of systematic intracranial hemorrhage after treatment compared with those with embolic-LVO. Furthermore, ICAS-LVO patients did not demonstrate a unique risk profile regarding recanalization, favorable outcomes (at 90 days), and mortality (at 90 days), resulting in comparable outcomes to embolic-LVO. However, a higher proportion of stent implantation and rescue therapy was observed in ICAS-LVO patients, highlighting the need for further investigation into the standardization of endovascular management for ICAS-LVO.