Long-term outcome trajectories and health-related quality of life after endovascular thrombectomy for large vessel occlusion stroke: A meta-analysis of randomized trials.

Randomized controlled trials (RCTs) have demonstrated the efficacy of endovascular thrombectomy (EVT) in improving 3-month functional outcomes in patients with acute ischemic stroke due to large vessel occlusion. However, long-term outcome trajectories and health-related quality of life (HRQoL) beyond this 3-month period remain less clearly defined. We conducted a systematic review and meta-analysis of RCTs reporting outcomes beyond 90 days after EVT. Functional outcomes were assessed using the modified Rankin Scale (mRS) with favorable outcomes defined as mRS 0-2 for small-to-medium core trials and mRS 0-3 for large core or basilar artery occlusion trials. Mortality and HRQoL outcomes were also evaluated. Risk ratios (RRs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Eight RCTs including 3,014 patients (1,670 received EVT) with follow-up to 24 months were analyzed. EVT was associated with a favorable shift in mRS distribution (RR = 1.71, 95% CI 1.49-1.96) and higher rates of favorable outcomes (RR = 1.68, 95% CI 1.32-2.14). Patients with large core infarcts and basilar occlusion showed greater treatment gain with EVT beyond three months. EVT reduced long-term mortality (RR = 0.80, 95% CI 0.72-0.88), while rates of moderate-to-severe disability (mRS 3-5) were similar between groups. HRQoL (measured by the EQ-5D index) was significantly improved in the EVT group (SMD = 0.34, 95% CI 0.13-0.55). Our findings indicate that EVT provides sustained benefits beyond 3 months in functional outcomes, survival, and HRQoL. Recovery patterns in patients with large core infarcts or basilar occlusion seem to be more pronounced over longer periods.