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Endovascular thrombectomy improves outcomes after anterior circulation stroke
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Results published in Stroke demonstrate increased odds for a good outcome after endovascular thrombectomy in patients with anterior circulation stroke.
“Our results reinforce the most current [randomized controlled trials] that [endovascular thrombectomy] improves good outcomes after anterior circulation stroke, regardless of prior IV therapy,” Chester K. Yarbrough, MD, MPHS, and fellow researchers from the Washington University School of Medicine, St. Louis, wrote.
The meta-analysis and systematic review included studies published from 1996 to 2015 that included: anterior circulation strokes in each arm; clinical outcomes in patients for stroke at 90 days with the modified Rankin Scale (mRS); at least 10 patients per group; and compared outcomes with a control arm.
Good outcomes were defined as mRS score of 0 to 2 at 90-day follow-up.
In all, nine of 23,809 studies met the inclusion criteria.
Primary analysis results indicated that endovascular thrombectomy increased the likelihood for good outcomes (OR = 1.75; 95% CI, 1.2-2.54).
According to secondary analysis, the following patients were more likely to experience a good outcome:
- younger patients (OR = 1.85; 95% CI, 1.5-2.28);
- older patients (OR = 1.93; 95% CI, 1.1-3.37);
- patients receiving IV thrombolysis (OR = 1.83; 95% CI, 1.46-2.31);
- patients not receiving IV thrombolysis (OR = 1.59; 95% CI, 0.86-2.95);
- patients with worse strokes (OR = 2.23; 95% CI, 1.56-3.18); and
- patients with more moderate strokes (OR = 1.72; 95% CI, 1.36-2.18).
In addition, rates of symptomatic intracranial hemorrhage and mortality were comparable for patients who received endovascular therapy vs. standard therapy.
“Recent large, well-executed [randomized controlled trials] suggest a number needed to treat of [about] 5 for [endovascular thrombectomy],” Yarbrough and colleagues wrote. “Given these findings, [endovascular thrombectomy] should be strongly considered for all patients with moderate-to-severe strokes affecting a proximal vessel of the anterior circulation.” – by Brian Ellis
Disclosure: One researcher reports consulting for MicroVention, Penumbra and Silk Road, and sharing stock ownership in Pulse Therapeutics. The other researchers report no relevant financial disclosures.
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