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Review
. 2015 Sep;17(3):268-81.
doi: 10.5853/jos.2015.17.3.268. Epub 2015 Sep 30.

Endovascular Recanalization Therapy in Acute Ischemic Stroke: Updated Meta-analysis of Randomized Controlled Trials

Keun-Sik Hong  1 , Sang-Bae Ko  2 , Ji Sung Lee  3 , Kyung-Ho Yu  4 , Joung-Ho Rha  5
Affiliations
Review

Endovascular Recanalization Therapy in Acute Ischemic Stroke: Updated Meta-analysis of Randomized Controlled Trials

Keun-Sik Hong et al. J Stroke. 2015 Sep.

Abstract

Background and purpose: Recent randomized clinical trials (RCTs) have demonstrated benefits of endovascular recanalization therapy (ERT) contrary to earlier trials. We aimed to estimate the benefits of ERT added to standard therapy in acute ischemic stroke.

Methods: From a literature search of RCTs testing ERT, we performed a meta-analysis to estimate an overall efficacy and safety of ERT for all trials, stent-retriever trials, and RCTs comparing ERT and intravenous tissue plasminogen activator (IV-TPA).

Results: We identified 15 relevant RCTs including 2,899 patients. For all trials, ERT was associated with increased good outcomes (odds ratio [OR] 1.79; 95% confidence interval [CI] 1.34, 2.40; P<0.001) compared to the control. ERT also increased no or minimal disability outcomes, good neurological recovery, good activity of daily living, and recanalization. ERT did not significantly increase symptomatic intracranial hemorrhage (SICH) (OR 1.19; 95% CI 0.83, 1.69; P=0.345) or death (OR 0.87; 95% CI 0.71, 1.05; P=0.151). In contrast, ERT significantly reduced extreme disability or death (OR 0.77; 95% CI 0.61, 0.97; P=0.025). Restricting to five stent-retriever trials comparing ERT plus IV-TPA vs. IV-TPA alone, the benefit was even greater for good outcome (OR 2.39; 95% CI 1.88, 3.04; P<0.001) and extreme disability or death (OR 0.57; 95% CI 0.41, 0.78; P=0.001). Restricting to eight RCTs comparing ERT (plus IV-TPA in six trials) with IV-TPA alone showed similar efficacy and safety.

Conclusions: This updated meta-analysis shows that ERT substantially improves clinical outcomes and reduces extreme disability or death without significantly increasing SICH compared to standard therapy.

Keywords: Acute ischemic stroke; Intra-arterial; Meta-analysis; Thrombectomy; Thrombolysis.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Selection of studies for inclusion in the meta-analysis.
Figure 2.
Figure 2.
Bias risk assessment for each trial.
Figure 3.
Figure 3.
Pooled estimates for achieving modified Rankin Scale (mRS) 0-2 outcomes with Endovascular recanalization therapy vs. control.
Figure 4.
Figure 4.
Pooled estimates for achieving modified Rankin Scale (mRS) 0-1 outcome with Endovascular recanalization therapy vs. control.
Figure 5.
Figure 5.
Pooled estimates for achieving partial or complete recanalization with Endovascular recanalization therapy vs. control.
Figure 6.
Figure 6.
Pooled estimates for symptomatic intracranial hemorrhage (SICH) with Endovascular recanalization therapy vs. control.
Figure 7.
Figure 7.
Pooled estimates for mortality with Endovascular recanalization therapy vs. control.
Figure 8.
Figure 8.
Pooled estimates for bed-ridden or dead outcome (mRS 5-6) with Endovascular recanalization therapy vs. control.
See this image and copyright information in PMC

References

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