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Endovascular Treatment with Stent-Retriever Devices for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

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Listed:
  • Chad K Bush
  • Dayaamayi Kurimella
  • Lee J S Cross
  • Katherine R Conner
  • Sheryl Martin-Schild
  • Jiang He
  • Changwei Li
  • Jing Chen
  • Tanika Kelly

Abstract

Importance: Acute ischemic stroke is a leading cause of death and disability worldwide. Several recent clinical trials have shown that endovascular treatment improves clinical outcomes among patients with acute ischemic stroke. Objective: To provide an overall and precise estimate of the efficacy of endovascular treatment predominantly using second-generation mechanical thrombectomy devices (stent-retriever devices) compared to medical management on clinical and functional outcomes among patients with acute ischemic stroke. Data Sources: MEDLINE, EMBASE, Cochrane Collaboration Central Register of Controlled Clinical Trials, Web of Science, and NIH ClinicalTrials.gov were searched through November 2015. Study Selection: Searches returned 3,045 articles. After removal of duplicates, two authors independently screened titles and abstracts to assess eligibility of 2,495 potentially relevant publications. From these, 38 full-text publications were more closely assessed. Finally, 5 randomized controlled trials of endovascular treatment with predominant use of retrievable stents were selected. Data Extraction and Synthesis: Three authors independently extracted information on participant and trial characteristics and clinical events using a standardized protocol. Random effects models were used to pool endovascular treatment effects across outcomes. Main Outcomes and Measures: The primary outcome was better functional outcome as measured on the modified Rankin Scale at 90 days of follow-up. Secondary outcomes included all-cause mortality and symptomatic intra-cerebral hemorrhage. Results: Five trials representing 1,287 patients were included. Overall, patients randomized to endovascular therapy experienced 2.22 times greater odds of better functional outcome compared to those randomized to medical management (95% CI, 1.66 to 2.98; P

Suggested Citation

  • Chad K Bush & Dayaamayi Kurimella & Lee J S Cross & Katherine R Conner & Sheryl Martin-Schild & Jiang He & Changwei Li & Jing Chen & Tanika Kelly, 2016. "Endovascular Treatment with Stent-Retriever Devices for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-19, January.
    • Handle: RePEc:plo:pone00:0147287
    DOI: 10.1371/journal.pone.0147287
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Viechtbauer, Wolfgang, 2010. "Conducting Meta-Analyses in R with the metafor Package," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 36(i03).
    3. Chao Lin & Nan Li & Kang Wang & Xin Zhao & Bai-Qiang Li & Lei Sun & Yi-Xing Lin & Jie-Mei Fan & Miao Zhang & Hai-Chen Sun, 2013. "Efficacy and Safety of Endovascular Treatment versus Intravenous Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-1, October.
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