Could Endovascular Thrombectomy Improve Outcomes in Ischemic Stroke?

Endovascular thrombectomy (ET) is associated with improved functional outcomes compared with standard medical care with intravenous tissue plasminogen activators (TPA) in patients with acute ischemic stroke, according to a recent study.

While previous research has shown that ET improves revascularization in patients with acute ischemic stroke, its effects on functional outcomes are less well defined.
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To further explore this issue, researchers conducted a meta-analysis of 8 trials involving 2423 patients (1313 who underwent ET and 1110 who received standard care).

Primary outcomes of the studies included improvement across modified Rnakin scale scores at 90 days, functional independence, angiographic revascularization at 24 hours, symptomatic intracranial hemorrhage, and all-cause mortality at 90 days.

Overall, ET was found to be associated with a significant proportional treatment benefit to functional independence scores, with functional independence at 90 days occurring in 44.6% of participants undergoing ET and 31.8% of those undergoing regular care. ET was also associated with significantly higher rates of angiographic revascularization at 24 hours (75.8% vs. 34.1%), but no difference was observed in rates of intracranial hemorrhage or all-cause mortality.

“Among patients with acute ischemic stroke, endovascular therapy with mechanical thrombectomy vs standard medical care with TPA was associated with improved functional outcomes and higher rates of angiographic revascularization, but no significant difference in symptomatic intracranial hemorrhage or all-cause mortality at 90 days,” they concluded.

—Michael Potts

Reference:
Badhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular thrombectomy for acute ischemic stroke. JAMA. 2015;314(17):1832-1843.