Meta-Analysis Supports Mechanical Thrombectomy for Acute Ischemic Stroke

December 2, 2015—In the Journal of the American College of Cardiology (JACC), Islam Y. Elgendy, MD, et al published findings from a meta-analysis of randomized trials on mechanical thrombectomy to treat acute ischemic stroke (2015;66:2498–3505). The investigators concluded that in acute ischemic stroke caused by large artery occlusion, mechanical thrombectomy after usual care was associated with improved functional outcomes compared with usual care alone and was found to be relatively safe, with no excess in intracranial hemorrhage. Additionally, there was a trend for reduction in all-cause mortality with mechanical thrombectomy. 

For the meta-analysis, the investigators included randomized trials that compared mechanical thrombectomy after usual care versus usual care alone (ie, intravenous thrombolysis) for acute ischemic stroke. Nine trials with 2,410 patients were available for analysis. Random-effects summary risk ratios (RR) were constructed using a DerSimonian and Laird model.

The investigators found that compared with usual care alone, mechanical thrombectomy was associated with a higher incidence of achieving good functional outcome, defined as a modified Rankin scale (mRS) of 0 to 2 (RR, 1.45; 95% confidence interval [CI], 1.22–1.72; P < .0001), and excellent functional outcome, defined as mRS 0 to 1 (RR, 1.67; 95% CI, 1.27–2.19; P < .0001), at 90 days.

There was a trend toward reduced all-cause mortality with mechanical thrombectomy (RR, 0.86; 95% CI, 0.72–1.02; P = .09). The risk of symptomatic intracranial hemorrhage was similar with either treatment modality (RR, 1.06; 95% CI, 0.73–1.55; P = .76), reported the investigators in JACC.