Objective:

To assess the long-term clinical benefits of endovascular thrombectomy (EVT) compared to standard medical care (MC) in patients with anterior circulation large vessel occlusion-related large ischemic infarcts, specifically focusing on outcomes beyond 90 days.

Key Findings:

• EVT significantly improved functional excellence (mRS 0–1; RR = 3.84, p < 0.001), functional independence (mRS 0–2; RR = 3.13, p < 0.001), and independent ambulation (mRS 0–3; RR = 2.01, p < 0.001) at long-term follow-up.
• Mortality rates were not significantly different between EVT and MC (RR = 0.90, p = 0.19).
• EVT reduced the risk of death or dependency (mRS 4–6; RR = 0.78, p < 0.001).
• Long-term follow-up showed more significant prognostic improvements with EVT compared to short-term follow-up.

Interpretation:

EVT provides significant long-term functional benefits for patients with anterior circulation LVO-related large ischemic infarcts, with enhanced outcomes observed over time, particularly in patients with shorter onset times and smaller infarct volumes, reinforcing the need for updated treatment guidelines.

Limitations:

• The analysis is limited to high-quality RCTs, which may not fully represent all patient populations, potentially skewing the generalizability of the results.
• Potential biases in study selection and reporting could affect the results, particularly in terms of outcome reporting and patient demographics.

Conclusion:

In patients with anterior circulation LVO-related large ischemic infarcts, EVT combined with MC leads to significant long-term functional improvements compared to MC alone, with benefits increasing over time.