Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2.50
Hdl Handle:
http://hdl.handle.net/10757/552402
Title:
Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors:
Osanai, Toshiya; Pasupuleti, Vinay; Deshpande, Abhishek; Thota, Priyaleela; Roman, Yuani; Hernández, Adrian V. ( 0000-0002-9999-4003 ) ; Uchino, Ken
Citation:
Osanai T, Pasupuleti V, Deshpande A, Thota P, Roman Y, Hernandez AV, et al. (2015) Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 10(4): e0122806. doi:10.1371/journal.pone.0122806
Publisher:
The Public Library of Science (PLOS)
Journal:
PLoS ONE
Issue Date:
6-May-2015
URI:
http://hdl.handle.net/10757/552402
DOI:
10.1371/journal.pone.0122806
Additional Links:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122806
Abstract:
Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.
Type:
info:eu-repo/semantics/article
Rights:
info:eu-repo/semantics/openAccess
Language:
eng
Description:
uchinok@ccf.org
Keywords:
Meta-analysis; Heparin; Hemorraghe; Systemic review
ISSN:
1932-6203
EISSN:
1932-6203

Full metadata record

DC FieldValue Language
dc.contributor.authorOsanai, Toshiyaes_PE
dc.contributor.authorPasupuleti, Vinayes_PE
dc.contributor.authorDeshpande, Abhishekes_PE
dc.contributor.authorThota, Priyaleelaes_PE
dc.contributor.authorRoman, Yuanies_PE
dc.contributor.authorHernández, Adrian V.es_PE
dc.contributor.authorUchino, Kenes_PE
dc.date.accessioned2015-05-06T17:04:59Zes_PE
dc.date.available2015-05-06T17:04:59Zes_PE
dc.date.issued2015-05-06es_PE
dc.identifier.citationOsanai T, Pasupuleti V, Deshpande A, Thota P, Roman Y, Hernandez AV, et al. (2015) Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 10(4): e0122806. doi:10.1371/journal.pone.0122806es_PE
dc.identifier.issn1932-6203es_PE
dc.identifier.doi10.1371/journal.pone.0122806es_PE
dc.identifier.urihttp://hdl.handle.net/10757/552402es_PE
dc.descriptionuchinok@ccf.orges_PE
dc.description.abstractBackground Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.eng
dc.formatapplication/pdfes_PE
dc.language.isoenges_PE
dc.publisherThe Public Library of Science (PLOS)es_PE
dc.relation.urlhttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122806es_PE
dc.rightsinfo:eu-repo/semantics/openAccesses_PE
dc.sourceUniversidad Peruana de Ciencias Aplicadas (UPC)es_PE
dc.sourceRepositorio Académico - UPCes_PE
dc.subjectMeta-analysises_PE
dc.subjectHeparines_PE
dc.subjectHemorraghees_PE
dc.subjectSystemic reviewes_PE
dc.titleAcute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trialses_PE
dc.typeinfo:eu-repo/semantics/articlees_PE
dc.identifier.eissn1932-6203es_PE
dc.identifier.journalPLoS ONEes_PE
dc.description.peer-reviewRevisión por pareses_PE
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