2015/06/12 by Partha Sardar, Saurav Chatterjee, Jay Giri +13 · 1 citation
Medicine · #Acute Ischemic Stroke Management #Intracerebral and Subarachnoid Hemorrhage Research #Stroke Rehabilitation and Recovery #Medicine #Ischaemic stroke #Randomized controlled trial #Meta-analysis #Fibrinolysis #Stroke (engine) #Acute stroke #Thrombolysis #Fibrinolytic agent #Intensive care medicine #Clinical trial #Internal medicine #Tissue plasminogen activator #Myocardial infarction #Ischemia
paper · pdf · doi:10.1093/eurheartj/ehv270
openalex publication_date 2015/06/12 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/02
AIMS: Evidence from randomized controlled trials (RCTs) evaluating possible benefits of endovascular therapy (EVT) for acute ischaemic stroke has shown conflicting results. The purpose of this meta-analysis was to systematically examine clinical outcomes in RCTs comparing the use of intravenous (IV) fibrinolysis alone to IV fibrinolysis plus EVT, for the treatment of acute ischaemic stroke. METHODS AND RESULTS: We selected English language RCTs, comparing EVT plus IV tissue-type plasminogen activator (tPA) (if eligible) with IV tPA alone in eligible patients for the treatment of acute ischaemic stroke. The primary endpoint was good functional outcome [modified Rankin Scale (mRS) of 0-2]. Other major endpoints of interest were all-cause mortality and symptomatic intracerebral haemorrhage (sICH). The meta-analysis included 8 RCTs that randomized 2423 patients with large-vessel, anterior-circulation stroke. EVT significantly improved the rate of functional independence (90-day mRS of 0-2) when compared with IV fibrinolysis [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.18-2.53, number needed to treat (NNT) = 9.3]. The all-cause mortality was lower with EVT compared with the control group; however, the result did not reach statistical significance (OR 0.89, 95% CI 0.68-1.15). The rate of sICH was not higher with EVT (OR 1.07, 95% CI 0.73-1.56). Analyses from only the recent trials (reported in 2014-15) showed further benefit (OR of mRS 0-2: 2.42, 95% CI 1.91-3.08, NNT = 5) with similar safety results. CONCLUSION: In centres with advanced systems of stroke care, EVT significantly improved functional outcomes (without compromising safety) in patients with acute ischaemic stroke due to anterior circulation, large artery occlusion, compared with standard therapy.