Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke: a meta-analysis

Abstract

Background and purposeIntravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone.MethodsDatabases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I2 (significance cut-off value >50%) with the Mantel–Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.ResultsSix studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group.ConclusionsEndovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone.

Endovascular Treatment over Standard Medical Therapy in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

“…Our study confirmed a trend toward increased risk of SICH in subjects with endovascular treatment confirming the result of other studies [16][17][18][19]. Since we evaluated the effectiveness of endovascular treatment on the top of standard therapy, this finding is not surprising and may be linked to the reperfusion of the ischemic area, in which there is a blood-brain-barrier alteration triggered by ischemia [29].…”

“…Delgado et al [19] in 2015 included only recent RCTs, in which mechanic thrombectomy was the only treatment administered in the intervention group. The outcome was significatively favored in the intervention group.…”

A survey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions

“…A summary of these data clearly demonstrates thrombectomy (plus intravenous tissue plasminogen activator when indicated) as the standard of care treatment for patients presenting with ELVO 11 12. This fact is reflected in the new American Heart Association/American Stroke Association guidelines, which state that all candidates meeting certain criteria for thrombectomy should undergo this procedure as a class I, level of evidence A recommendation 13.…”

Challenges in experimental stroke research : The 17β-estradiol example

“…More research is needed to disentangle the multiple effects in order to sort out the most important components that could perhaps be used also in more basic settings [19]. The second strategy, thrombectomy, was earlier questioned but has now been proven benefi cial with modern equipment [20]. Moreover, despite the increased knowledge regarding the causative factors of stroke, e.g.…”