{
  "abstract": "Background Whether perfusion ‘mismatch’ modifies the effect of endovascular thrombectomy (EVT) in patients with large core ischemic stroke remains uncertain.Methods We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) enrolling patients with large infarcts and reporting outcomes by perfusion mismatch status, defined as a mismatch ratio ≥1.2 and a mismatch volume ≥10 mL. A Mantel-Haenszel fixed-effect model was used to pool ORs for three 90-day outcomes: independent ambulation (modified Rankin Scale (mRS) score 0–3, primary outcome), good outcome (mRS score 0–2), severe disability or death (mRS score 5–6). We tested for interaction to assess whether the effect of thrombectomy differed according to mismatch status.Results Three RCTs met the inclusion criteria, totaling 863 patients, of whom 113 (13%) had no perfusion mismatch (47% from LASTE). There was no significant interaction between mismatch status and EVT efficacy across any of the outcomes. In the mismatch subgroup, EVT significantly improved outcomes compared with medical therapy (mRS 0–3: OR=2.14, 95% CI 1.57 to 2.90; mRS score 0–2: OR=3.22, 95% CI 2.14 to 4.85; mRS score 5–6: OR=0.66, 95% CI 0.50 to 0.89; all I² = 0%). In the no-mismatch subgroup, OR values were not significant for both mRS score 0–3 (OR=2.32, 95% CI 0.84 to 6.38) and mRS score 5–6 (OR=0.73, 95% CI 0.34 to 1.57); OR for mRS score 0–2 was neutral (OR=1.00, 95% CI 0.15 to 6.55).Conclusions No interaction was found between mismatch status and EVT effect. However, in patients without mismatch, effect estimates were non-significant for EVT. Additional data are needed to better assess treatment benefit in this subgroup.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France",
        "Stanford Stroke Center, Stanford Medicine, Stanford, California, USA",
        "Institut de génomique fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France",
        "Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France"
      ],
      "name": "Adrien ter Schiphorst"
    },
    {
      "affiliations": [
        "Department of Neurology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France",
        "Institut de génomique fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France",
        "Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France"
      ],
      "name": "Caroline Arquizan"
    },
    {
      "affiliations": [
        "Department of Biostatistics, Centre Hospitalier Universitaire de Lille, Lille, France"
      ],
      "name": "Julien Labreuche"
    },
    {
      "affiliations": [
        "Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France",
        "Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France"
      ],
      "name": "Guillaume Turc"
    },
    {
      "affiliations": [
        "Stanford Stroke Center, Stanford Medicine, Stanford, California, USA"
      ],
      "name": "Nicole Yuen"
    },
    {
      "affiliations": [
        "Stanford Stroke Center, Stanford Medicine, Stanford, California, USA"
      ],
      "name": "Michael Mlynash"
    },
    {
      "affiliations": [
        "Stanford Stroke Center, Stanford Medicine, Stanford, California, USA"
      ],
      "name": "Maarten G Lansberg"
    },
    {
      "affiliations": [
        "Department of Radiology, Stanford Medicine, Stanford, California, USA"
      ],
      "name": "Jeremy J Heit"
    },
    {
      "affiliations": [
        "Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France"
      ],
      "name": "Bertrand Lapergue"
    },
    {
      "affiliations": [
        "Department of Vascular Neurology, Centre Hospitalier Regional Universitaire de Lille, Lille, France"
      ],
      "name": "Hilde Henon"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Centre Hospitalier Universitaire de Lille, Lille, France"
      ],
      "name": "Nasreddine Nouri"
    },
    {
      "affiliations": [
        "Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse, France",
        "Toulouse Clinical Investigations Centers 1436, Toulouse, France"
      ],
      "name": "Jean François Albucher"
    },
    {
      "affiliations": [
        "Toulouse Clinical Investigations Centers 1436, Toulouse, France",
        "Department of Neuroradiology, Hôpital Pierre Paul Riquet, Toulouse, France"
      ],
      "name": "Christophe Cognard"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France"
      ],
      "name": "Gaultier Marnat"
    },
    {
      "affiliations": [
        "Department of Neurolology, CHU Bordeaux, Hôpital Pellegrin, Bordeaux, France"
      ],
      "name": "Igor Sibon"
    },
    {
      "affiliations": [
        "Department of Neurology, Cooper University Hospital, Cooper Medical School at Rowan University, Camden, New Jersey, USA"
      ],
      "name": "Tudor G Jovin"
    },
    {
      "affiliations": [
        "Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse, France"
      ],
      "name": "Jean-Marc Olivot"
    },
    {
      "affiliations": [
        "Stanford Stroke Center, Stanford Medicine, Stanford, California, USA"
      ],
      "name": "Gregory W Albers"
    },
    {
      "affiliations": [
        "Institut de génomique fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France",
        "Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France"
      ],
      "name": "Vincent Costalat"
    }
  ],
  "title": "Does perfusion mismatch modify the benefit of thrombectomy in large core stroke? A meta-analysis of trials",
  "uid": "41a7d761-fdff-552e-b6da-17a07cc47b8c"
}