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Clinical Summary

Stroke: endovascular thrombectomy boosts survival in meta-analysis

Takeaway

  • Patients with acute ischemic stroke have better 90-day survival when they receive endovascular thrombectomy as compared with medical therapy alone.

Why this matters

Key results

  • Compared with medical therapy, endovascular thrombectomy reduced risk for 90-day mortality (15.0% vs 18.7%; risk ratio, 0.81; P=.03).
  • Number needed to treat to prevent 1 death from any cause: 27.
  • Pattern was similar when trials stratified by patient enrollment window:
    • Early window (onset of symptoms onward; risk ratio, 0.83; P=.06).
    • Late window (6 hours postonset onward; risk ratio, 0.76; P=.38).
  • Endovascular thrombectomy and medical therapy were statistically indistinguishable on risk for intracranial hemorrhage (4.2% vs 4.0%; risk ratio, 1.11; P=.65).

Study design

  • Meta-analysis of 10 randomized controlled trials among 2313 patients cited for recommendations on endovascular thrombectomy vs medical therapy in 2018 American Stroke Association/American Heart Association guidelines.
  • Main outcomes: risks for 90-day mortality and 90-day intracranial hemorrhage.
  • Funding: None.

Limitations

  • Protocols varied across trials.
  • Bias from early stopping of some trials.
  • Longer-term survival not yet clear.
  • Most patients receiving endovascular thrombectomy in early-window trials also received intravenous thrombolysis.

References


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