Confirming the results of trials such as MR CLEAN and EXTEND-IA, a meta-analysis indicates that the use of endovascular intervention for the treatment of acute ischemic stroke is associated with improved functional outcomes and higher rates of functional independence at 90 days compared to standard treatment with intravenous tissue plasminogen activator (IV tPA).
While the current standard of treatment for ischemic stroke remains IV tPA, the narrow therapeutic window has shifted focus to endovascular interventions, primarily mechanical thrombectomy. To examine clinical outcomes in patients with acute ischemic stroke, Jetan H. Badhiwala, MD, of the University of Toronto, and colleagues performed a meta-analysis of data collected from 8 trials involving 2,423 patients (mean [SD] age, 67.4 [14.4] years; 1131 [46.7%] women), including 1,313 who underwent endovascular thrombectomy and 1,110 who received standard care with IV tPA.
The researchers found that endovascular therapy was associated with a significant proportional treatment benefit across modified Rankin scale scores. Functional independence at 90 days (Rankin score 0-2) occurred in 557 of 1,293 (44.6%) patients who underwent endovascular therapy (95% CI, 36.6%-52.8%) compared to 351 of 1,094 (31.8%) patients treated with standard care (95% CI, 24.6%-40.0%). Over 75% of patients who underwent endovascular thrombectomy experienced agiographic revasculartization at 24 hours compared to just over 34% of patients treated with standard care (OR, 6.49; 95% CI, 4.79-8.79; P < .001) . However, no significant difference between groups was observed in rates of symptomatic intracranial hemorrhage within 90 days (70 events [5.7%] vs 53 events [5.1%]; OR, 1.12; 95% CI, 0.77-1.63; P = .56) or all-cause mortality at 90 days (218 deaths [15.8%] vs 201 deaths [17.8%]; OR, 0.87; 95% CI, 0.68-1.12; P = .27).
With as few as 10% of ischemic stroke patients eligible for treatment with IV tPA, “additional trials are needed to systematically study the relationship of patient-, disease-, and treatment-related variables with outcomes following mechanical thrombectomy, and to identify the ideal patient to undergo endovascular therapy,” the authors wrote.