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Eur Heart J. 2015 Sep 14;36(35):2373-80. doi: 10.1093/eurheartj/ehv270. Epub 2015 Jun 12.

Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials.

Author information

1
Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA parthasardarmd@gmail.com.
2
St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, NY, USA.
3
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
4
University of Massachusetts Medical School, Worcester, MA, USA.
5
Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
6
Saint Michael's Medical Center, Newark, NJ, USA.
7
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
8
Temple University School of Medicine, Philadelphia, PA, USA.
9
University Hospitals Case Medical Center, Cleveland, OH, USA.
10
Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA.
11
Radiology and Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
12
Texas Tech University Health Sciences Center, El Paso, TX, USA.
13
Division of Vascular Neurology, University of Utah, Salt Lake City, UT, USA.
14
Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY, USA.

Abstract

AIMS:

Evidence from randomized controlled trials (RCTs) evaluating possible benefits of endovascular therapy (EVT) for acute ischaemic stroke has shown conflicting results. The purpose of this meta-analysis was to systematically examine clinical outcomes in RCTs comparing the use of intravenous (IV) fibrinolysis alone to IV fibrinolysis plus EVT, for the treatment of acute ischaemic stroke.

METHODS AND RESULTS:

We selected English language RCTs, comparing EVT plus IV tissue-type plasminogen activator (tPA) (if eligible) with IV tPA alone in eligible patients for the treatment of acute ischaemic stroke. The primary endpoint was good functional outcome [modified Rankin Scale (mRS) of 0-2]. Other major endpoints of interest were all-cause mortality and symptomatic intracerebral haemorrhage (sICH). The meta-analysis included 8 RCTs that randomized 2423 patients with large-vessel, anterior-circulation stroke. EVT significantly improved the rate of functional independence (90-day mRS of 0-2) when compared with IV fibrinolysis [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.18-2.53, number needed to treat (NNT) = 9.3]. The all-cause mortality was lower with EVT compared with the control group; however, the result did not reach statistical significance (OR 0.89, 95% CI 0.68-1.15). The rate of sICH was not higher with EVT (OR 1.07, 95% CI 0.73-1.56). Analyses from only the recent trials (reported in 2014-15) showed further benefit (OR of mRS 0-2: 2.42, 95% CI 1.91-3.08, NNT = 5) with similar safety results.

CONCLUSION:

In centres with advanced systems of stroke care, EVT significantly improved functional outcomes (without compromising safety) in patients with acute ischaemic stroke due to anterior circulation, large artery occlusion, compared with standard therapy.

KEYWORDS:

Endovascular; Meta-analysis; Outcomes; Stroke; Thrombolytics

PMID:
26071599
DOI:
10.1093/eurheartj/ehv270
[Indexed for MEDLINE]

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