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A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke

Citation

Balami, JS and Sutherland, BA and Edmunds, LD and Grunwald, IQ and Neuhaus, AA and Hadley, G and Karbalai, H and Metcalf, KA and DeLuca, GC and Buchan, AM, A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke, International journal of stroke, 10, (8) pp. 1168-1178. ISSN 1747-4930 (2015) [Refereed Article]

Copyright Statement

Copyright 2015 The Authors Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1111/ijs.12618

Abstract

BACKGROUND: Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed.

AIM: To perform a systematic review and a meta-analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke.

SUMMARY OF REVIEW: Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0-2) [odds ratio 156 (132-185), P < 000001]. There was a tendency toward decreased mortality [odds ratio 084 (067-105), P = 012], and symptomatic intracerebral hemorrhage was not increased [odds ratio 103 (071-149), P = 088] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 223 (177-281, P < 000001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial.

CONCLUSIONS: There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.

Item Details

Item Type:Refereed Article
Keywords:endovascular therapy/treatment, intravenous thrombolysis, ischemic stroke, meta-analysis, systematic review, thrombectomy
Research Division:Medical and Health Sciences
Research Group:Neurosciences
Research Field:Central Nervous System
Objective Division:Expanding Knowledge
Objective Group:Expanding Knowledge
Objective Field:Expanding Knowledge in the Medical and Health Sciences
Author:Sutherland, BA (Dr Brad Sutherland)
ID Code:113413
Year Published:2015
Web of Science® Times Cited:29
Deposited By:Office of the School of Medicine
Deposited On:2016-12-22
Last Modified:2017-11-06
Downloads:0

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