Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis.

Area of Science:

• Neurology
• Interventional Cardiology
• Vascular Surgery

Background:

• Endovascular intervention for acute ischemic stroke improves revascularization, but functional outcomes vary.
• Subgroup effects of endovascular intervention require better definition.

Purpose of the Study:

• To examine the association between endovascular mechanical thrombectomy and clinical outcomes in acute ischemic stroke patients.

Main Methods:

• Systematic search of multiple databases (MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library) through August 2015.
• Meta-analysis of eligible randomized clinical trials comparing endovascular thrombectomy with standard medical care (including intravenous tPA).
• Analysis of functional independence (mRS 0-2), revascularization, symptomatic intracranial hemorrhage, and all-cause mortality at 90 days.

Main Results:

• Endovascular therapy showed a significant benefit across modified Rankin Scale (mRS) scores (OR, 1.56).
• Functional independence (mRS 0-2) was higher with endovascular therapy (44.6%) versus standard care (31.8%).
• Significantly higher angiographic revascularization rates (75.8% vs 34.1%) were observed with endovascular thrombectomy; no significant differences in symptomatic intracranial hemorrhage or 90-day mortality.

Conclusions:

• Endovascular therapy with mechanical thrombectomy is associated with improved functional outcomes in acute ischemic stroke patients.
• Mechanical thrombectomy significantly increases angiographic revascularization rates.
• No significant increase in symptomatic intracranial hemorrhage or all-cause mortality was observed compared to standard medical care.