title: Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials.
abstract: OBJECTIVE
  Evidence from randomized controlled trials (RCTs) evaluating possible benefits of endovascular therapy (EVT) for acute ischaemic stroke has shown conflicting results. The purpose of this meta-analysis was to systematically examine clinical outcomes in RCTs comparing the use of intravenous (IV) fibrinolysis alone to IV fibrinolysis plus EVT, for the treatment of acute ischaemic stroke.
  
  
  RESULTS
  We selected English language RCTs, comparing EVT plus IV tissue-type plasminogen activator (tPA) (if eligible) with IV tPA alone in eligible patients for the treatment of acute ischaemic stroke. The primary endpoint was good functional outcome [modified Rankin Scale (mRS) of 0-2]. Other major endpoints of interest were all-cause mortality and symptomatic intracerebral haemorrhage (sICH). The meta-analysis included 8 RCTs that randomized 2423 patients with large-vessel, anterior-circulation stroke. EVT significantly improved the rate of functional independence (90-day mRS of 0-2) when compared with IV fibrinolysis [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.18-2.53, number needed to treat (NNT) = 9.3]. The all-cause mortality was lower with EVT compared with the control group; however, the result did not reach statistical significance (OR 0.89, 95% CI 0.68-1.15). The rate of sICH was not higher with EVT (OR 1.07, 95% CI 0.73-1.56). Analyses from only the recent trials (reported in 2014-15) showed further benefit (OR of mRS 0-2: 2.42, 95% CI 1.91-3.08, NNT = 5) with similar safety results.
  
  
  CONCLUSIONS
  In centres with advanced systems of stroke care, EVT significantly improved functional outcomes (without compromising safety) in patients with acute ischaemic stroke due to anterior circulation, large artery occlusion, compared with standard therapy.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA parthasardarmd@gmail.com.
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.affiliation: St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, NY, USA.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Anwar
authors.initials: A
authors.lastname: Tandar
authors.affiliation: Saint Michael's Medical Center, Newark, NJ, USA.
authors.forename: Parijat
authors.initials: P
authors.lastname: Sen
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Huston
authors.affiliation: Division of Cardiovascular Medicine, University of Utah Health Science Center, University of Utah, 30 North 1900 East, Salt Lake City, UT 84132, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Ryan
authors.affiliation: Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Riyaz
authors.initials: R
authors.lastname: Bashir
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Sahil A
authors.initials: SA
authors.lastname: Parikh
authors.affiliation: Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: White
authors.affiliation: Radiology and Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.affiliation: Texas Tech University Health Sciences Center, El Paso, TX, USA.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Division of Vascular Neurology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.affiliation: Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, NY, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
mesh_terms: D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular; Meta-analysis; Outcomes; Stroke; Thrombolytics