Endovascular treatment vs. intravenous thrombolysis alone for ischaemic stroke: a meta-analysis of randomised controlled trials.
OBJECTIVE
Our aim was to assess the effects on clinical outcomes of endovascular treatment vs. thrombolysis alone in patients with ischaemic stroke.


RESULTS
PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomised trials comparing endovascular treatment vs. intravenous thrombolysis alone in acute ischaemic stroke. Data were pooled by meta-analysis using a fixed-effects or a random-effects model, as appropriate. Eight studies enrolling 2,423 participants were included. Compared with thrombolysis alone, endovascular treatment was associated with higher rates of 90-day modified Rankin Scale (mRS) scores of 0-2 (42.4% vs. 31.8%, odds ratio [OR] 1.71, 95% confidence interval [CI]: 1.17-2.49, p=0.005, number needed to treat to benefit [NNTB]=8), and of recanalisation at 24-30 hours (76.9% vs. 39.6%, OR 4.49, 95% CI: 2.41-8.38, p<0.001, NNTB=2.9), with similar risk of symptomatic intracranial haemorrhage (5.4% vs. 4.9%, OR 1.08, 95% CI: 0.75-1.56, p=0.67) and all-cause death (15.3% vs. 16.6%, OR 0.86, 95% CI: 0.69-1.07, p=0.18). In subgroup analysis the benefits of endovascular treatment were restricted to studies where stent retriever systems were routinely employed.


CONCLUSIONS
In patients with acute ischaemic stroke, endovascular treatment is a safe and more effective strategy than intravenous thrombolysis alone.
Division of Clinical and Interventional Cardiology, Department of Cardiovascular Medicine, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Giuseppe
G
Ferrante
Nunzio Paolo
NP
Nuzzi
Giulio Giuseppe
GG
Stefanini
Francesco
F
Asteggiano
Simona
S
Marcheselli
Gianluigi
G
Condorelli
Bernhard
B
Reimers
D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D057510:Endovascular Procedures / Q000379:methods; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000150:complications / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator