Supplementary Material for: Endovascular Treatment Plus Medical Treatment vs Medical Treatment Alone in Ischemic Stroke: A Systematic Review and Meta-analysis

Introduction This study was conducted to assess the hypothesis that endovascular treatment in addition to medical treatment improve stroke mortality and post-stroke disability. Methods In this systematic review and meta-analysis, the studies were included if they were randomized controlled trials in design and compared between endovascular treatment and medical therapy vs medical therapy alone in stroke management. Results The search yielded 22 articles that included 5,049 patients. The analysis showed significant association between the intervention and reduction in disability measured by Modified Rankin Scale (mRS) (mRS=0-2) (OR=1.61; 95%CI:1.27-2.06) and National Institute of Health Stroke Scale (NIHSS) (NIHSS=0-15) (OR=2.13; 95%CI: 1.04-4.34). Also, we found a significant difference in disability scores between the intervention and the medical therapy group (mRS WMD=-0.59; 95%CI: -1.15- -0.02, NIHSS WMD= -4.52; 95%CI: -6.32- -2.72). Additionally, there was significant reduction in mortality in the intervention group (OR=0.79; 95%CI: 0.68-0.92). There was no significant difference in the rate of any serious adverse effects between the two study groups except for asymptomatic intracerebral hemorrhage. Conclusion Our study provides strong evidence stemmed from randomized clinical trials that endovascular treatment combined with medical therapy is superior to medical therapy alone in the management of stroke.