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- Title
Mechanical thrombectomy for emergent large vessel occlusion: a critical appraisal of recent randomized controlled clinical trials.
- Authors
Tsivgoulis, Georgios; Safouris, Apostolos; Katsanos, Aristeidis H.; Arthur, Adam S.; Alexandrov, Andrei V.
- Abstract
Background and Purpose After numerous attempts to prove efficacy for endovascular treatment of ischemic stroke, a series of recent randomized controlled clinical trials ( RCTs) established fast mechanical thrombectomy ( MT) as a safe and effective novel treatment for emergent large vessel occlusion ( ELVO) in the anterior cerebral circulation. Methods We reviewed five recent RCTs that evaluated the safety and efficacy of MT in ELVO patients and captured available information on recanalization/reperfusion, symptomatic intracranial hemorrhage ( sICH), clinical outcome, and mortality. MT was performed with stent retrievers, aspiration techniques, or a combination of these endovascular approaches. We applied meta-analytical methodology to evaluate the pooled effect of MT on recanalization/reperfusion, sICH, functional independence (modified Rankin scale score of 0-2) and 3-month mortality rates in comparison to best medical therapy ( BMT). Results MT was associated with increased likelihood of complete recanalization/reperfusion ( RR: 2.22; 95% CI: 1.89-2.62; P < 0.00001) and 3-month functional independence ( RR: 1.72; 95% CI: 1.48-1.99; P < 0.00001) without any heterogeneity across trials ( I2 = 0%). The absolute benefit increase in MT for complete recanalization/reperfusion and functional independence was 44 ( NNT = 2) and 16 ( NNT = 6), respectively. MT was not associated with increased risk of 3-month mortality (15% with MT vs. 19% with BMT) and sICH (4.6% with MT vs. 4.3% with BMT), while small heterogeneity was detected across the included trials ( I2 < 25%). Conclusions MT is a safe and highly effective treatment for patients with ELVO in the anterior circulation. For every six ELVO patients treated with MT three more will achieve complete recanalization at 24 h following symptom onset and one more will be functionally independent at 3 months in comparison to BMT.
- Subjects
CLINICAL trials; TISSUE plasminogen activator; TRANSIENT ischemic attack; ARTERIAL occlusions; MYOCARDIAL infarction
- Publication
Brain & Behavior, 2016, Vol 6, Issue 2, pn/a
- ISSN
2162-3279
- Publication type
Article
- DOI
10.1002/brb3.418