Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review.

Authors:
Prof. Dr. Gustavo Saposnik, MD, MSc, FAHA, FRCPC
Prof. Dr. Gustavo Saposnik, MD, MSc, FAHA, FRCPC
University of Toronto
Associate Professor of Mdicine (Neurology), Director Stroke Outcomes Research Canada (www.sorcan.ca)
Stroke, Health Services Research, Decision Neuroscience, Neuroeconomics
Toronto, ON | Canada

Can J Neurol Sci 2016 Jul 13;43(4):455-60. Epub 2016 Apr 13.

11Department of Clinical Neurosciences,Hotchkiss Brain Institute,Cumming School of Medicine,University of Calgary,Calgary,AB,Canada.

Although intravenous thrombolysis increases the probability of a good functional outcome in carefully selected patients with acute ischemic stroke, a substantial proportion of patients who receive thrombolysis do not have a good outcome. Several recent trials of mechanical thrombectomy appear to indicate that this treatment may be superior to thrombolysis. We therefore conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of new-generation mechanical thrombectomy devices with intravenous thrombolysis (if eligible) compared with intravenous thrombolysis (if eligible) in patients with acute ischemic stroke caused by a proximal intracranial occlusion. We systematically searched seven databases for randomized controlled trials published between January 2005 and March 2015 comparing stent retrievers or thromboaspiration devices with best medical therapy (with or without intravenous thrombolysis) in adults with acute ischemic stroke. We assessed risk of bias and overall quality of the included trials. We combined the data using a fixed or random effects meta-analysis, where appropriate. We identified 1579 studies; of these, we evaluated 122 full-text papers and included five randomized control trials (n=1287). Compared with patients treated medically, patients who received mechanical thrombectomy were more likely to be functionally independent as measured by a modified Rankin score of 0-2 (odds ratio, 2.39; 95% confidence interval, 1.88-3.04; I2=0%). This finding was robust to subgroup analysis. Mortality and symptomatic intracerebral hemorrhage were not significantly different between the two groups. Mechanical thrombectomy significantly improves functional independence in appropriately selected patients with acute ischemic stroke.

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http://dx.doi.org/10.1017/cjn.2016.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926268PMC
July 2016
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References

(Supplied by CrossRef)
Complete recovery after early intraarterial recombinant tissue plasminogen activator thrombolysis of carotid T occlusion
Rabinstein et al.
Am J Neuroradiol 2002

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