title: Endovascular Thrombectomy for Anterior Circulation Stroke: Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Stroke affects ≈700,000 patients annually. Recent randomized controlled trials comparing endovascular thrombectomy (ET) with medical therapy, including intravenous thrombolysis (IVT) with tissue-type plasminogen activator, have shown effectiveness of ET for some stroke patients. The study objective is to evaluate the effect of ET on good outcome in stroke patients.
  
  
  METHODS
  We searched PubMed, Embase, Web of Science, SCOPUS, ClinicalTrials.gov, and Cochrane databases to identify original research publications between 1996 and 2015 that (1) reported clinical outcomes in patients for stroke at 90 days with the modified Rankin Scale; (2) included at least 10 patients per group; (3) compared outcome with a control arm, and (4) included anterior circulation strokes in each arm. Two authors reviewed articles for inclusion independently.
  
  
  RESULTS
  Nine of 23 809 studies met inclusion criteria. In primary analysis, ET was associated with increased odds for good outcome (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.20-2.54). In secondary analysis, younger patients (OR, 1.85; 95% CI, 1.50-2.28), older patients (OR, 1.93; 95% CI, 1.10-3.37), patients receiving intravenous thrombolysis (OR, 1.83; 95% CI, 1.46-2.31), patients with worse strokes (OR, 2.23; 95% CI, 1.56-3.18), and patients with more moderate strokes (OR, 1.72; 95% CI, 1.36-2.18) had increased odds for good outcome. Symptomatic intracranial hemorrhage and mortality were similar between ET and control patients. No evidence of publication bias was seen.
  
  
  CONCLUSIONS
  ET improves good outcomes after anterior circulation stroke. ET should be strongly considered for all patients presenting within 6 hours of onset with a stroke affecting a proximal, anterior circulation vessel without a contraindication to ET.
authors.affiliation: From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.).
authors.forename: Chester K
authors.initials: CK
authors.lastname: Yarbrough
authors.affiliation: From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.).
authors.forename: Charlene J
authors.initials: CJ
authors.lastname: Ong
authors.affiliation: From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.).
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Beyer
authors.affiliation: From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.).
authors.forename: Kim
authors.initials: K
authors.lastname: Lipsey
authors.affiliation: From the Department of Neurological Surgery (C.K.Y., C.P.D.), Department of Neurology (C.J.O., C.P.D.), Bernard Becker Medical Library (K.L.), and Mallinckrodt Institute of Radiology (C.P.D.), Washington University School of Medicine, St. Louis, MO; and Washington University School of Medicine, St. Louis, MO (A.B.B.). derdeync@wustl.edu.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D020521:Stroke / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: intracranial hemorrhage; meta-analysis; review, systematic; stroke; thrombectomy