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Journal of Neurorestoratology 2021, 9(3): 166-176 https://doi.org/10.26599/JNR.2021.9040014
Review Article | Open Access | Issue | Published: 22 December 2021

Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

Show Author's Information Jia Feng1,  Zhihan Zhu2,  Ahmed Waqas1,2,  Lukui Chen1( )
Department of Neurosurgery, Neuroscience Center, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, Guangdong, China
School of Medicine, Southeast University, Nanjing 210009, Suzhou, China
Keywords:
ischemic stroke, thrombectomy, tissue-type plasminogen activator, risk ratio
Cite this article:
Feng J, Zhu Z, Waqas A, et al. Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial. Journal of Neurorestoratology, 2021, 9(3): 166-176. https://doi.org/10.26599/JNR.2021.9040014
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Abstract Full text About this article
Objective:

To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.

Methods:

A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.

Results:

As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).

Conclusion:

Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.


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Abstract
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About this article

Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

Show Author's information Jia Feng1, Zhihan Zhu2, Ahmed Waqas1,2, Lukui Chen1( )
Department of Neurosurgery, Neuroscience Center, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, Guangdong, China
School of Medicine, Southeast University, Nanjing 210009, Suzhou, China

Abstract

Objective:

To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.

Methods:

A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.

Results:

As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).

Conclusion:

Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.

Keywords: ischemic stroke, thrombectomy, tissue-type plasminogen activator, risk ratio

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Publication history
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Publication history

Received: 17 February 2021
Accepted: 25 June 2021
Published: 22 December 2021
Issue date: September 2021

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© The authors 2021

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This article is published with open access at http://jnr.tsinghuajournals.com

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