title: Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review.
abstract: Although intravenous thrombolysis increases the probability of a good functional outcome in carefully selected patients with acute ischemic stroke, a substantial proportion of patients who receive thrombolysis do not have a good outcome. Several recent trials of mechanical thrombectomy appear to indicate that this treatment may be superior to thrombolysis. We therefore conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of new-generation mechanical thrombectomy devices with intravenous thrombolysis (if eligible) compared with intravenous thrombolysis (if eligible) in patients with acute ischemic stroke caused by a proximal intracranial occlusion. We systematically searched seven databases for randomized controlled trials published between January 2005 and March 2015 comparing stent retrievers or thromboaspiration devices with best medical therapy (with or without intravenous thrombolysis) in adults with acute ischemic stroke. We assessed risk of bias and overall quality of the included trials. We combined the data using a fixed or random effects meta-analysis, where appropriate. We identified 1579 studies; of these, we evaluated 122 full-text papers and included five randomized control trials (n=1287). Compared with patients treated medically, patients who received mechanical thrombectomy were more likely to be functionally independent as measured by a modified Rankin score of 0-2 (odds ratio, 2.39; 95% confidence interval, 1.88-3.04; I2=0%). This finding was robust to subgroup analysis. Mortality and symptomatic intracerebral hemorrhage were not significantly different between the two groups. Mechanical thrombectomy significantly improves functional independence in appropriately selected patients with acute ischemic stroke.
authors.affiliation: 1Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Lambrinos
authors.affiliation: 1Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
authors.forename: Alexis K
authors.initials: AK
authors.lastname: Schaink
authors.affiliation: 1Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
authors.forename: Irfan
authors.initials: I
authors.lastname: Dhalla
authors.affiliation: 2Departments of Medical Imaging and Surgery,University of Toronto,ON,Canada.
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.affiliation: 3Toronto Western Hospital and University Health Network,Toronto,ON,Canada.
authors.forename: Leanne K
authors.initials: LK
authors.lastname: Casaubon
authors.affiliation: 1Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Sikich
authors.affiliation: 5Interventional Neuroradiology,The Ottawa Hospital,Ottawa Hospital Research Institute,Ottawa,ON,Canada.
authors.forename: Cheemun
authors.initials: C
authors.lastname: Lum
authors.affiliation: 6Neuroradiology Department of Medical Imaging,St. Michael's Hospital,Toronto,ON,Canada.
authors.forename: Aditya
authors.initials: A
authors.lastname: Bharatha
authors.affiliation: 2Departments of Medical Imaging and Surgery,University of Toronto,ON,Canada.
authors.forename: Vitor Mendes
authors.initials: VM
authors.lastname: Pereira
authors.affiliation: 7Ottawa Stroke Program,Ottawa,ON,Canada.
authors.forename: Grant
authors.initials: G
authors.lastname: Stotts
authors.affiliation: 8Stroke Outcomes Research Centre,St. Michael's Hospital,University of Toronto,Toronto,ON,Canada.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: 9Ontario Stroke Network,ON,Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kelloway
authors.affiliation: 1Evidence Development and Standards, Health Quality Ontario,Toronto,ON,Canada.
authors.forename: Xuanqian
authors.initials: X
authors.lastname: Xie
authors.affiliation: 11Department of Clinical Neurosciences,Hotchkiss Brain Institute,Cumming School of Medicine,University of Calgary,Calgary,AB,Canada.
authors.forename: Michael D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
mesh_terms: D002545:Brain Ischemia / Q000150:complications*; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000209:etiology* / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*
keywords: acute ischemic stroke; endovascular treatment; mechanical thrombectomy; meta-analysis; systematic review