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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
External counterpulsation for acute ischaemic stroke
1Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Insights
External counterpulsation (ECP) may improve neurological function in acute ischaemic stroke patients. However, current evidence is limited due to poor study quality, necessitating further research.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Rehabilitation
Background:
- External counterpulsation (ECP) is a non-invasive therapy that augments diastolic arterial pressure, potentially improving cerebral blood flow.
- ECP has been investigated as a therapeutic option for patients experiencing acute ischaemic stroke.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of external counterpulsation (ECP) in the treatment of acute ischaemic stroke.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (e.g., MEDLINE, EMBASE, CENTRAL) up to June 2011.
- Included were randomized controlled trials (RCTs) comparing ECP with sham treatment or no treatment in acute ischaemic stroke patients.
- Two independent reviewers assessed trial quality, extracted data, and checked for adverse events.
Main Results:
- Two RCTs with a total of 160 patients were included in the review.
- ECP demonstrated a significant increase in the number of participants with improved neurological impairment (Risk Ratio: 1.75, 95% CI: 1.37 to 2.23).
- Data on mortality or long-term dependency were not reported, and only one trial reported no adverse events.
Conclusions:
- The existing studies on ECP for acute ischaemic stroke suffer from poor methodological quality.
- Reliable conclusions regarding the efficacy and safety of ECP cannot be drawn from the current evidence.
- High-quality, large-scale randomized controlled trials are essential to determine the true benefit of ECP in this patient population.
Background:
External counterpulsation (ECP) may improve cerebral blood flow, and it has been proposed as a potential therapy for patients with ischaemic stroke.
Objectives:
To assess the efficacy and safety of ECP for acute ischaemic stroke.
Search Methods:
We searched the Cochrane Stroke Group Trials Register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 Issue 2), MEDLINE (1948 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (Allied and Complementary Medicine) (1985 to June 2011), China Biological Medicine Database (CBM) (1978 to June 2011), Chinese National Knowledge Infrastructure (CNKI) (1979 to June 2011), Chinese Science and Technique Journals Database (VIP) (1989 to June 2011) and Wanfang Data (1984 to June 2011). We also searched ongoing trials registers, reference lists and relevant conference proceedings and contacted authors and manufacturers of external counterpulsation devices.
Selection Criteria:
Randomised controlled trials (RCTs) in which ECP (started within seven days of stroke onset) was compared with sham treatment or no treatment, or ECP plus routine treatment was compared with routine treatment alone, in patients with acute ischaemic stroke.
Data Collection And Analysis:
Two review authors independently assessed trial quality and extracted data, checked for adverse events data and contacted trialists for missing information.
Main Results:
We included two trials involving 160 patients. Numbers of death or dependent patients at the end of at least three months follow-up were not reported in either of the included trials. The outcome measure used in the included trials was only the number of participants with improvement of neurological impairment after treatment according to the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) or self-making criteria. ECP was associated with a significant increase in the number of participants whose neurological impairment improved (risk ratio (RR) 1.75, 95% confidence interval (CI) 1.37 to 2.23). Only one trial reported no adverse events.
Authors' Conclusions:
The methodological quality of the included studies was poor, and reliable conclusions could not be drawn from the present data. High-quality and large-scale RCTs are needed.
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