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
- 2018 American Stroke Association/American Heart Association guidelines recommend endovascular thrombectomy because of its improvement of functional recovery, but effect on mortality is unclear.
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
References