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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review
Anna Lambrinos1, Alexis K Schaink1, Irfan Dhalla1
11Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
Summary
Mechanical thrombectomy significantly improves functional independence for acute ischemic stroke patients. This endovascular treatment offers better outcomes compared to medical therapy alone.
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Intravenous thrombolysis improves outcomes in acute ischemic stroke but is insufficient for many patients.
- Emerging evidence suggests mechanical thrombectomy may be superior to thrombolysis.
- Proximal intracranial occlusion is a critical factor in stroke outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the clinical effectiveness and safety of new-generation mechanical thrombectomy devices.
- To compare mechanical thrombectomy (with or without thrombolysis) against intravenous thrombolysis (with or without best medical therapy) in acute ischemic stroke.
- To evaluate outcomes in patients with acute ischemic stroke caused by proximal intracranial occlusion.
Main Methods:
- Systematic search of seven databases for randomized controlled trials (RCTs) published between January 2005 and March 2015.
- Inclusion of RCTs comparing stent retrievers or thromboaspiration devices with best medical therapy (with or without intravenous thrombolysis).
- Meta-analysis of data from five included RCTs (n=1287) with risk of bias and quality assessment.
Main Results:
- Mechanical thrombectomy significantly increased functional independence (modified Rankin score 0-2) compared to medical treatment (OR 2.39; 95% CI 1.88-3.04).
- This improved functional outcome was consistent across subgroup analyses.
- No significant differences were observed in mortality or symptomatic intracerebral hemorrhage rates between mechanical thrombectomy and medical treatment groups.
Conclusions:
- Mechanical thrombectomy is a safe and effective treatment for selected patients with acute ischemic stroke due to proximal intracranial occlusion.
- The procedure significantly enhances the likelihood of functional independence post-stroke.
- This meta-analysis supports the use of mechanical thrombectomy as a superior treatment option over medical therapy alone for eligible stroke patients.
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