title: Meta-Analysis of Local Endovascular Therapy for Acute Ischemic Stroke.
abstract: A meta-analysis was performed to assess randomized controlled trials comparing local endovascular therapy (with and without intravenous thrombolysis) versus standard care (intravenous thrombolysis alone when appropriate) for acute ischemic stroke. Local endovascular therapy showed a significant improvement in functional independence versus standard care (odds ratio, 1.779; 95% confidence interval, 1.262-2.507; P < .001). This benefit strengthened further on subgroup analyses of trials in which a majority of cases used stent retrievers, trials with intravenous thrombolysis use in both arms when appropriate, and trials that required preprocedural imaging of all patients. There were no significant differences between arms in terms of mortality, hemicraniectomy, intracranial hemorrhage, and cerebral edema rates (P > .05). In conclusion, in the treatment of acute ischemic stroke, local endovascular therapy leads to improved functional independence compared with standard care.
authors.affiliation: Department of Diagnostic Radiology, University of Toronto, Toronto, Ontario, Canada. Electronic address: sean.kennedy@medportal.ca.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Kennedy
authors.affiliation: Department of Diagnostic Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada.
authors.forename: Mark O
authors.initials: MO
authors.lastname: Baerlocher
authors.affiliation: Department of Biology, Mount Allison University, Sackville, New Brunswick, Canada.
authors.forename: Felix
authors.initials: F
authors.lastname: Baerlocher
authors.affiliation: Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Socko
authors.affiliation: Department of Interventional Radiology, Reading Health System, West Reading, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Sacks
authors.affiliation: Department of Radiology, Stratton Medical Center, Albany, New York.
authors.forename: Boris
authors.initials: B
authors.lastname: Nikolic
authors.affiliation: Department of Radiology, Our Lady of Lourdes Regional Medical Center, Louisiana State University School of Medicine, Lafayette, Louisiana.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Wojak
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Virginia.
authors.forename: Ziv J
authors.initials: ZJ
authors.lastname: Haskal
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents