title: Improved clinical outcome 3 months after endovascular treatment, including thrombectomy, in patients with acute ischemic stroke: a meta-analysis.
abstract: OBJECTIVE
  Intravenous thrombolysis with tissue plasminogen activator is standard treatment in acute stroke today. The benefit of endovascular treatment has been questioned. Recently, studies evaluating endovascular treatment and intravenous thrombolysis compared with intravenous thrombolysis alone, have reported improved outcome for the intervention group. The aim of this study was to perform a meta-analysis of randomized controlled trials comparing endovascular treatment in addition to intravenous thrombolysis with intravenous thrombolysis alone.
  
  
  METHODS
  Databases were searched for eligible randomized controlled trials. The primary outcome was a functional neurological outcome after 90 days. A secondary outcome was severe disability and death. Data were pooled in the control and intervention groups, and OR was calculated on an intention to treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I(2) (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.
  
  
  RESULTS
  Six studies met the eligibility criteria, and data from 1569 patients were analyzed. A higher probability of a functional neurological outcome after 90 days was found for the intervention group (OR 2, 95% CI 2 to 3). There was a significantly higher probability of death and severe disability in the control group compared with the intervention group.
  
  
  CONCLUSIONS
  Endovascular treatment in addition to intravenous thrombolysis for acute ischemic stroke leads to an improved clinical outcome after 3 months, compared with patients receiving intravenous thrombolysis alone.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Falk-Delgado
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Kuntze Söderqvist
authors.affiliation: Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
authors.forename: Jian
authors.initials: J
authors.lastname: Fransén
authors.affiliation: Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Alberto
authors.initials: A
authors.lastname: Falk-Delgado
mesh_terms: D002545:Brain Ischemia / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: Angiography; Intervention; Stent; Stroke; Thrombectomy