Endovascular thrombectomy (EVT) is associated with higher 90-day survival rates after acute ischemic stroke (AIS) compared with medical therapy alone, according to a meta-analysis of evidence from the 2018 American Stroke Association/American Heart Association (ASA/AHA) guidelines published in JAMA Neurology.
Investigators extracted data from guideline-referenced randomized controlled trials on endovascular therapy vs medical therapy for AIS that were cited in the 2018 ASA/AHA guideline. A total of 10 trials met the inclusion criteria and were included in the analysis. The risk for 90-day mortality and 90-day intracranial hemorrhage was the main outcome for the study. Analyses were performed in early-window EVT trials vs late-window EVT trials, which included patients from the onset of symptoms onward and patients from 6 hours after symptom onset, respectively.
In the 10 randomized controlled trials that compared EVT vs medical therapy for AIS, a total of 2313 patients were included in the pooled analysis. The use of EVT was associated with a greater reduction in the risk for 90-day mortality by 3.7% vs medical therapy alone (15.0% vs 18.7%, respectively; risk ratio [RR], 0.81; 95% CI, 0.68-0.98; P =.03). There were trends toward lower 90-day mortality in early-window trials (RR, 0.83; 95% CI, 0.67-1.01; P =.06) and late-window trials only (RR, 0.76; 95% CI, 0.41-1.40; P =.38).
No difference was found between EVT and medical therapy in regard to the intracranial hemorrhage risk (4.2% vs 4.0%, respectively; RR, 1.11; 95% CI, 0.71-1.72; P =.65).
The researchers noted that the limitation associated with the analyzed trials included the heterogeneity in trial protocols.
“Taken together, there is considerable evidence in guideline-referenced [randomized controlled trials] that EVT significantly benefits survival during the first 90 days after AIS compared with medical therapy alone,” the researchers wrote. “We cannot help but see the parallels: endovascular strategies may well turn out to be as successful in AIS as in myocardial infarction.”
Lin Y, Schulze V, Brockmeyer M, et al. Endovascular thrombectomy as a means to improve survival in acute ischemic stroke: a meta-analysis [published online April 8, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.0525