title: A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke.
abstract: BACKGROUND
  Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed.
  
  
  OBJECTIVE
  To perform a systematic review and a meta-analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke.
  
  
  RESULTS
  Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0-2) [odds ratio 1·56 (1·32-1·85), P < 0·00001]. There was a tendency toward decreased mortality [odds ratio 0·84 (0·67-1·05), P = 0·12], and symptomatic intracerebral hemorrhage was not increased [odds ratio 1·03 (0·71-1·49), P = 0·88] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 2·23 (1·77-2·81, P < 0·00001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial.
  
  
  CONCLUSIONS
  There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.
authors: Centre for Evidence Based Medicine, University of Oxford, Oxford, UK.|Norfolk and Norwich University Teaching Hospital NHS Trust, Norwich, UK.
authors: Joyce S
authors: JS
authors: Balami
authors: Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors: Brad A
authors: BA
authors: Sutherland
authors: Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors: Laurel D
authors: LD
authors: Edmunds
authors: Neuroscience, Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Chelmsford, UK.|Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK.|CardioVascular Center Frankfurt (CVC Frankfurt), Frankfurt, Germany.
authors: Iris Q
authors: IQ
authors: Grunwald
authors: Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors: Ain A
authors: AA
authors: Neuhaus
authors: Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors: Gina
authors: G
authors: Hadley
authors: Medical Sciences Division, University of Oxford, Oxford, UK.
authors: Hasneen
authors: H
authors: Karbalai
authors: Norfolk and Norwich University Teaching Hospital NHS Trust, Norwich, UK.
authors: Kneale A
authors: KA
authors: Metcalf
authors: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
authors: Gabriele C
authors: GC
authors: DeLuca
authors: Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.|Medical Sciences Division, University of Oxford, Oxford, UK.|Acute Vascular Imaging Centre, University of Oxford, Oxford, UK.
authors: Alastair M
authors: AM
authors: Buchan
mesh_terms: D002545:Brain Ischemia / Q000601:surgery*; D057510:Endovascular Procedures; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy
keywords: endovascular therapy/treatment; intravenous thrombolysis; ischemic stroke; meta-analysis; systematic review; thrombectomy