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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical Thrombectomy for Large Ischemic Stroke: A Systematic Review and Meta-analysis
Qi Li1, Mohamad Abdalkader1, James E Siegler1
1From the Department of Neurology (Q.L., Q.H., Y.D., Z.Q.), the 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China; Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Cooper Neurological Institute (J.E.S.), Cooper University Hospital, Camden, NJ; Rhode Island Hospital (S.Y.), Brown University, Providence; University Hospitals Cleveland Medical Center (A.S., D.P.), Case Western Reserve University, OH; Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Texas Stroke Institute (A.J.Y.), Dallas Fort Worth; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; University Institute of Diagnostic and Interventional Neuroradiology (J.K.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Neurology and Neurosurgery (R.G.N.), University of Pittsburgh Medical Center, PA; Neurology (J.L.S.), University of California in Los Angeles; Neurology (L.L.), The Second Affiliated Hospital of Harbin Medical University, China; Neurology (H.S.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou; Neurology (Q.Y.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqinq, China; and Department of Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA.
Endovascular thrombectomy (EVT) significantly improves functional outcomes for stroke patients with large vessel occlusion (LVO) and large ischemic cores compared to medical management. EVT does not increase the risk of symptomatic intracranial hemorrhage, offering a safer treatment option.
Area of Science:
- Neurology
- Interventional Cardiology
- Public Health
Background:
- Large vessel occlusion (LVO) stroke with a large ischemic core presents a significant clinical challenge.
- Endovascular thrombectomy (EVT) is increasingly considered for these patients, but its efficacy and safety compared to medical management (MM) require robust evaluation.
Approach:
- A systematic review and meta-analysis synthesized data from 3 randomized controlled trials (RCTs) and 10 cohort studies.
- Searches included PubMed, Embase, Cochrane Library, and Web of Science up to February 10, 2023.
- Primary outcome was independent ambulation (modified Rankin Scale [mRS] 0-3); secondary outcomes included functional independence (mRS 0-2) and safety endpoints like symptomatic intracranial hemorrhage (sICH).
Key Points:
- RCT analysis demonstrated that EVT significantly improved 90-day functional outcomes, including independent ambulation (mRS 0-3, RR 1.78) and functional independence (mRS 0-2, RR 2.59).
- EVT did not significantly increase the risk of symptomatic intracranial hemorrhage (sICH, RR 1.83, p=0.07) or early mortality (RR 0.95, p=0.61) in the RCTs.
- Cohort study analysis corroborated improved functional outcomes with EVT without a significant increase in sICH incidence.
Conclusions:
- EVT is an effective treatment for patients with LVO stroke and large ischemic cores, leading to better functional outcomes than MM.
- The procedure is associated with a comparable risk of symptomatic intracranial hemorrhage, making it a favorable therapeutic option.
- Ongoing RCTs are expected to provide further insights into the management of this critical patient group.
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