title: Endovascular Treatment with Stent-Retriever Devices for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Collaboration Central Register of Controlled Clinical Trials, Web of Science, and NIH ClinicalTrials.gov were searched through November 2015.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 < 0.0001). Endovascular therapy was not associated with mortality [OR (95% CI), 0.78 (0.54, 1.12); P = 0.1056] or symptomatic intracerebral hemorrhage [OR (95% CI), 1.19 (0.69, 2.05); P = 0.5348]. Meta-regression analysis suggested that shorter times from stroke onset to groin puncture and from stroke onset to reperfusion result in better functional outcomes in ischemic stroke patients (P = 0.0077 and P = 0.0089). There were no significant differences in the beneficial effects of endovascular treatment on functional outcomes across categories of gender, age, stroke severity, ischemic changes on computed tomography, or intravenous tissue plasminogen activator administration.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated superior functional outcomes in subjects receiving endovascular treatment compared to medical management. Further, this analysis showed that acute ischemic stroke patients may receive enhanced functional benefit from earlier endovascular treatment.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.|Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.|Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Chad K
authors.initials: CK
authors.lastname: Bush
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Dayaamayi
authors.initials: D
authors.lastname: Kurimella
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Lee J S
authors.initials: LJ
authors.lastname: Cross
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Conner
authors.affiliation: Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.|Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.|Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Changwei
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.|Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Tanika
authors.initials: T
authors.lastname: Kelly
mesh_terms: D000208:Acute Disease; D001925:Brain Damage, Chronic / Q000209:etiology / Q000517:prevention & control; D002545:Brain Ischemia / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000295:instrumentation / Q000706:statistics & numerical data; D009026:Mortality; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator