Abstract
Objective
To consolidate the evidence from randomized trials for the use of endovascular therapy
(ET) in patients with acute ischemic stroke.
Methods
We searched major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled
Trials, Cochrane Database of Systematic Reviews, and Scopus) from their inception
to February 12, 2013, for randomized trials evaluating the efficacy of ET compared
with standard of care for acute ischemic stroke. Pooled absolute and relative risk
estimates were synthesized by using a random-effects model. Heterogeneity was assessed
by using Q statistic and I2 statistic. Subset analysis was performed for patients with severe stroke (National
Institutes of Health Stroke Scale score ≥20). The study was conducted from January
15, 2013 to April 30, 2013.
Results
Of the 1252 retrieved articles, 5 randomized trials enrolling 1197 patients with acute
ischemic stroke were included. Seven hundred eleven patients received ET, and 486
received intravenous (IV) tissue plasminogen activator. There was no significant improvement
in any of the outcomes in patients receiving ET compared with those receiving IV thrombolysis.
On subgroup analysis, ET was found to have better outcomes in patients with severe
stroke (National Institutes of Health Stroke Scale score ≥20), showing a dose-response
gradient and improving excellent, good, and fair outcomes by an additional 4%, 7%,
and 13%, respectively, compared with IV thrombolysis.
Conclusion
Overall, ET is not superior to IV thrombolysis for acute ischemic strokes (level B
recommendation). However, ET showed promise and improved outcomes in patients with
severe strokes, but the evidence is limited due to sample size. There is a need for
further trials evaluating the role of ET in this high-risk group.
Abbreviations and Acronyms:
AAN (American Academy of Neurology), AIS (acute ischemic stroke), ET (endovascular therapy), IMS (Interventional Management of Stroke), IV (intravenous), mRS (modified Rankin Scale), MR-RESCUE (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy), NIHSS (National Institute of Health Stroke Scale), RCT (randomized controlled trial), RR (risk ratio), sICH (symptomatic intracranial hemorrhage), tPA (tissue plasminogen activator)To read this article in full you will need to make a payment
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Article Info
Footnotes
Grant Support: This work was supported by CTSA grant UL1 TR000135 from the National Center for Advancing Translational Sciences , a component of the National Institutes of Health (NIH). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.
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© 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
