Meta-Analysis Supports Benefit of Endovascular Stroke Therapy

Summary and Comment |
November 20, 2015

Meta-Analysis Supports Benefit of Endovascular Stroke Therapy

  1. Hooman Kamel, MD

In a meta-analysis of all available randomized clinical trials, mechanical thrombectomy led to better outcomes than standard medical care alone.

  1. Hooman Kamel, MD

The benefit of endovascular therapy for acute ischemic stroke was unproven until several recent randomized trials. To synthesize the findings of these trials, investigators performed a meta-analysis of published reports of all randomized clinical trials comparing intra-arterial use of a microcatheter for mechanical thrombectomy versus standard medical therapy, which included intravenous thrombolysis.

Of eight eligible studies, three were published in 2013 (IMS III, MR RESCUE, and SYNTHESIS) and five in 2015 (MR CLEAN, ESCAPE, EXTEND-IA, REVASCAT, and SWIFT-PRIME). Across studies, mean patient age ranged from 66 to 71 years and the median NIH Stroke Scale score ranged from 13 to 17. In a pooled analysis, the odds of functional independence (modified Rankin Scale score ≤2) at 90 days was higher in the 1313 patients who underwent thrombectomy (44.6%) than in the 1110 who received standard care (31.8%; P=0.005). There were no significant differences in rates of symptomatic intracranial hemorrhage (5.7% vs. 5.1%) or death (15.8% vs. 17.8%). The benefit of endovascular therapy was seen only in trials published in 2015, in patients with confirmed arterial occlusion, after use of intravenous thrombolysis, and when stent retrievers were used.

Comment

This rigorous meta-analysis helps synthesize the findings from a flurry of recent randomized trials on endovascular therapy for stroke. The pooled analysis confirms the overall benefit of mechanical thrombectomy when added to standard medical care. Subgroup analyses confirm the widespread impression that the most effective approach involves the use of stent retrievers in patients with confirmed arterial occlusion who are pretreated with intravenous thrombolysis.

Editor Disclosures at Time of Publication

  • Disclosures for Hooman Kamel, MD at time of publication Speaker’s bureau Genentech Grant / Research support National Institutes of Health/National Institute of Neurological Disorders and Stroke, Michael Goldberg Stroke Research Fund Editorial boards PLOS One; Scientific Reports

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.