Safety and Efficacy of Endovascular Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation in Latin American and the Caribbean Patients: A Systematic Review and Meta-analysis

Abstract

Objective: To evaluate the safety and efficacy of endovascular thrombectomy (EVT) in adults with posterior circulation acute ischemic stroke (PCAIS) in Latin America and the Caribbean (LATAC). Background: While recent studies have shown improved outcomes with EVT in PCAIS, data from LATAC remain limited. This region presents unique sociodemographic and healthcare challenges, with patients often experiencing worse stroke outcomes. Methods: Studies assessing EVT in LATAC adults with PCAIS were included. Primary outcomes were favorable functional outcome (90-day mRS 0–3), successful recanalization rate (mTICI 2b-3), symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. A single-arm meta-analysis using a random-effects model was performed, and heterogeneity was evaluated using I² statistics. Results: Eight observational studies comprising 210 patients were included. Approximately one third of patients in cohort studies received bridging IVT prior to EVT. The pooled proportion of favorable functional outcome was 33% (95% CI: 26–42), successful recanalization was achieved in 85% of cases (95% CI: 77–90), mortality was 31% (95% CI: 17–50), and sICH was 7% (95% CI: 4–14). Only two studies identified independent outcome predictors via multivariate analysis. Most studies had low to moderate risk of bias. Conclusions: EVT for PCAIS in LATAC shows comparable mortality and sICH rates to larger RCTs; however, functional outcomes may be less favorable. This may reflect regional disparities in stroke systems of care.