Safety and Efficacy of Stent Retrievers for the Management of Acute Ischemic Stroke

Marmagkiolis, Konstantinos; Hakeem, Abdul; Çilingiroğlu, Mehmet; Gündoğdu, Betül; Iliescu, Cezar; Tsitlakidou, Despina; Katramados, Angelos

doi:10.1016/j.jcin.2015.07.021

Cited by 28 publications

(18 citation statements)

References 27 publications

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“…Based on these results both studies concluded rapid endovascular treatment to be superior to medical treatment in improving functional independence and mortality rates for patients with acute ischemic strokes. Many smaller studies and meta‐analysis have confirmed this finding, however, data comparing different thrombectomy devices is lacking …”

Section: Acute Ischemic Stroke Interventionsmentioning

confidence: 97%

“…Many smaller studies and metaanalysis have confirmed this finding, however, data comparing different thrombectomy devices is lacking. [24][25][26][27][28] One large trial examined the use of magnesium sulfate as a neuroprotective agent in acute stroke patients. Saver et al 29 randomized 1,700 patients to receive intravenous magnesium sulfate or placebo within 2 hours after symptom onset.After 90 days, there was no significant difference in disability outcomes (Rankin scale; 2.7% vs. 2.7%; P ¼ 1.00), mortality (15.4% vs. 15.5%; P ¼ 0.95), or all serious adverse events (51.2% vs. 50.1%; P ¼ 0.67) between the magnesium sulfate and placebo arms.…”

Section: Acute Ischemic Stroke Interventionsmentioning

confidence: 99%

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Endovascular Interventional Cardiology: 2015 in Review

White

Elder

Mohamad

et al. 2016

J Interven Cardiology

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Section: Acute Ischemic Stroke Interventionsmentioning

confidence: 97%

Section: Acute Ischemic Stroke Interventionsmentioning

confidence: 99%

Endovascular Interventional Cardiology: 2015 in Review

White

Elder

Mohamad

et al. 2016

J Interven Cardiology

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“…The direction of eff ect favored endovascular treatment across all strata, although the adjusted ORs for treatment were not significant for patients younger than 50 years, those with a low ASPECTS or NIHSS score, or in those with an M2 segment thrombus. Eff ects favoring intervention were significant in several subgroups of special interest, including patients older than 80 years, those randomized more than 300 min after symptom onset, and those not receiving intravenous t-PA 9,16 . There was also no evidence of heterogeneity of treatment eff ect across the pre-specified subgroups for achievement of functional independence (mRS 0-2) at 90 days.…”

Section: Meta-analysismentioning

confidence: 99%

Endovascular Therapy for Acute Stroke

Politi

Kastrup

Marmagkiolis

et al. 2017

Progress in Cardiovascular Diseases

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Stroke is the most common cause of permanent disability, the second most common cause of dementia, and the fourth most common cause of death in the Western world. Recently, based on positive multicenter randomized clinical trials, endovascular therapy for acute stroke has undergone a revolution. Routine mechanical thrombectomy in addition to intravenous thrombolysis has been shown to provide excellent outcomes for patients with proximal anterior circulation occlusions. This procedure reduces disability and benefits are seen across a wide range of age and initial stroke severity. Important features that affect treatment decisions include time of presentation, the patient's clinical status, imaging characteristics, and lab tests. Under optimal conditions, it should be available to patients 24/7, similar to systems offering prompt percutaneous coronary interventions to patients with acute ST-segment elevation myocardial infarctions.

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“…Endovascular treatment (EVT) with mechanical thrombectomy is safe and effective in patients with acute anterior circulation stroke, compared with intravenous tissue plasminogen activator (IV-tPA) (Badhiwala et al, 2015;Elgendy, Kumbhani, Mahmoud, Bhatt, & Bavry, 2015;Kim, Jeon, Kim, Choi, & Cho, 2018;Marmagkiolis et al, 2015). However, the primary clinical outcomes are affected by many factors, such as the site of occlusion, stroke severity, and patient management factors including blood pressure during thrombectomy (Adams et al, 2007;Hungerford et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

et al. 2018

Brain and Behavior

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BackgroundEndovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking.MethodsPubMed and EMBASE searches were used to select full‐text articles comparing the effects of GA and CS on functional outcome and complications in patients with anterior circulation ischemic stroke. Enrolled patients were assigned to receive endovascular treatment with CS or GA, with a primary outcome of functional independency within 90 days. Secondary outcomes included intracranial hemorrhage, all‐cause mortality at 90 days, pneumonia, and intraprocedural complications.ResultsThirteen studies (3 RCTs and 10 observational studies), which included 3,857 patients (CS = 2,129, GA = 1,728), were eligible for the analysis. The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA (OR, 1.42; 95% CI, 1.05–1.92, p = 0.02); and the risk of mortality was higher with GA compared with CS; furthermore, CS was associated with lower rate of intracranial hemorrhage. In RCTs, GA was associated with increased functional independence (OR, 0.55; 95% CI, 0.34–0.89, p = 0.01) and successful reperfusion (OR, 0.51; 95% CI, 0.30–0.89, p = 0.02).ConclusionsIn the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large‐scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes.

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Safety and Efficacy of Stent Retrievers for the Management of Acute Ischemic Stroke

Abstract: On the basis of the results of this meta-analysis of RCTs, ET with stent retrievers appears as a safe and effective therapeutic option for acute ischemic stroke due to large vessel occlusion.

Cited by 28 publications

References 27 publications

Endovascular Interventional Cardiology: 2015 in Review

Endovascular Interventional Cardiology: 2015 in Review

Endovascular Therapy for Acute Stroke

Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

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