Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Authors
Osanai, ToshiyaPasupuleti, Vinay
Deshpande, Abhishek
Thota, Priyaleela
Roman, Yuani
Hernández, Adrian V.
Uchino, Ken
Issue Date
2015-05-06
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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.0122806Publisher
The Public Library of Science (PLOS)Journal
PLoS ONEDOI
10.1371/journal.pone.0122806Abstract
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/articleRights
info:eu-repo/semantics/openAccessLanguage
engDescription
uchinok@ccf.orgISSN
1932-6203EISSN
1932-6203ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0122806
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