AI Chat Paper
Note: Please note that the following content is generated by AMiner AI. SciOpen does not take any responsibility related to this content.
{{lang === 'zh_CN' ? '文章概述' : 'Summary'}}
{{lang === 'en_US' ? '中' : 'Eng'}}
Chat more with AI
Powered by AMiner. Clicking this button will take you away from SciOpen.
Home Journal of Neurorestoratology Article
PDF (1.8 MB)
Cite
EndNote(RIS) BibTeX
Collect
Submit Manuscript AI Chat Paper
Show Outline
Outline
Show full outline
Hide outline
Outline
Show full outline
Hide outline
Review Article | Open Access

Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

Jia Feng1, Zhihan Zhu2, Ahmed Waqas1,2, Lukui Chen1( )
Department of Neurosurgery, Neuroscience Center, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, Guangdong, China
School of Medicine, Southeast University, Nanjing 210009, Suzhou, China
Show Author Information

Abstract

Objective:

To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.

Methods:

A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.

Results:

As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).

Conclusion:

Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.

Keywords

ischemic strokethrombectomytissue-type plasminogen activatorrisk ratio

References

[1]
Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990- 2010: findings from the Global Burden of Disease Study 2010. Lancet 2014, 383(9913): 245-254.
Crossref Google Scholar
[2]
Lee KY, Han SW, Kim SH, et al. Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients. Stroke 2007, 38(1): 192-193.
Crossref Google Scholar
[3]
Bhatia R, Hill MD, Shobha N, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke. Stroke 2010, 41(10): 2254-2258.
Crossref Google Scholar
[4]
Thomalla G, Simonsen CZ, Boutitie F, et al. MRI- guided thrombolysis for stroke with unknown time of onset. N Engl J Med 2018, 379(7): 611-622.
Crossref Google Scholar
[5]
Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013, 368(10): 914-923.
Crossref Google Scholar
[6]
Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-pa versus t-pa alone for stroke. N Engl J Med 2013, 368(10): 893-903.
Crossref Google Scholar
[7]
Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013, 368(10): 904-913.
Crossref Google Scholar
[8]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-pa vs. T-pa alone in stroke. N Engl J Med 2015, 372(24): 2285-2295.
Crossref Google Scholar
[9]
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015, 372(11): 1009-1018.
Google Scholar
[10]
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015, 372(11): 1019-1030.
Google Scholar
[11]
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015, 372(24): 2296-2306.
Crossref Google Scholar
[12]
Bracard S, Ducrocq X, Mas JL, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (thrace): A randomised controlled trial. Lancet Neurol 2016, 15(11): 1138-1147.
Crossref Google Scholar
[13]
Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015, 372(1): 11-20.
Crossref Google Scholar
[14]
Khoury NN, Darsaut TE, Ghostine J, et al. Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial. J Neuroradiol 2017, 44(3): 198-202.
Crossref Google Scholar
[15]
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018, 378(1): 11-21.
Google Scholar
[16]
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018, 378(8): 708-718.
Crossref Google Scholar
[17]
Elgendy IY, Kumbhani DJ, Mahmoud A, et al. Mechanical thrombectomy for acute ischemic stroke: A meta-analysis of randomized trials. J Am Coll Cardiol 2015, 66(22): 2498-2505.
Crossref Google Scholar
[18]
Touma L, Filion KB, Sterling LH, et al. Stent retrievers for the treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized clinical trials. JAMA Neurol 2016, 73(3): 275-281.
Crossref Google Scholar
[19]
Emprechtinger R, Piso B, Ringleb PA. Thrombectomy for ischemic stroke: meta-analyses of recurrent strokes, vasospasms, and subarachnoid hemorrhages. J Neurol 2017, 264(3): 432-436.
Crossref Google Scholar
[20]
Liberati A, Altman DG, Tetzlaff J, et al. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009, 62(10): e1-e34
Crossref Google Scholar
[21]
Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011, 343: d5928.
Crossref Google Scholar
[22]
Egger M, Smith GD, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997, 315(7109): 629-634.
Crossref Google Scholar
[23]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2019, 50(12): e344-e418.
Crossref Google Scholar
[24]
Fonarow GC, Smith EE, Saver JL, et al. Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: Patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. Circulation 2011, 123(7): 750-758.
Crossref Google Scholar
Journal of Neurorestoratology
Volume 9 Issue 3,
September 2021
Pages 166-176
DOI: 10.26599/JNR.2021.9040014
Cite this article:
Feng J, Zhu Z, Waqas A, et al. Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial. Journal of Neurorestoratology, 2021, 9(3): 166-176. https://doi.org/10.26599/JNR.2021.9040014

874

Views

129

Downloads

5

Crossref

6

Web of Science

0

Scopus

Altmetrics
Received: 17 February 2021
Accepted: 25 June 2021
Published: 22 December 2021
© The authors 2021

This article is published with open access at http://jnr.tsinghuajournals.com
Return