Endovascular thrombectomy for the treatment of acute ischemic stroke

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Acute ischemic stroke. Intervention: Endovascular thrombectomy plus standard treatment vs. Standard treatment alone. Primary outcome: Efficacy and/or safety in acute ischemic stroke.

Q: What does this research mean for the field?

Endovascular thrombectomy combined with standard therapy is superior to standard care alone for acute ischemic stroke, though patient selection criteria limit the proportion of eligible patients who benefit. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Cleusa P. Ferri; Anna Maria Buehler; Uri Adrian Prync Flato; Jefferson Gomes Fernandes

doi:10.1590/0004-282x20150182

November 20, 2015Arquivos de Neuro-PsiquiatriaOpen Access

Endovascular thrombectomy for the treatment of acute ischemic stroke

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Key result

Endovascular thrombectomy beats standard medical care alone in 5 of 8 acute ischemic stroke trials.

Why the study?

Few patients benefit from standard treatment for acute ischemic stroke, motivating a systematic evaluation of the efficacy and safety of endovascular thrombectomy and identification of ongoing randomized trials.

Key Points

Assess the efficacy and safety of endovascular thrombectomy combined with standard care compared to standard care alone in acute ischemic stroke, and identify ongoing randomized controlled trials.
Systematically searched Medline and Embase through June 15, 2015, for published randomized controlled trials evaluating endovascular thrombectomy in acute ischemic stroke.
Searched the WHO International Clinical Trial Registry Platform, ClinicalTrials.gov, and the ISRCTN registry to identify ongoing randomized controlled trials.
Five out of eight published randomized controlled trials demonstrated the superiority of combining endovascular thrombectomy with standard care over standard care alone.
Among 13 ongoing randomized controlled trials identified, three were halted, one had not started, one had unknown status, and eight were scheduled to conclude between 2016 and 2020.

Study Design

Type

Systematic Review

PICO

P

Population

Patients with acute ischemic stroke included across 8 published and 13 ongoing randomized controlled trials.

I

Intervention / Comparator

Endovascular thrombectomy plus standard treatment vs Standard treatment alone

O

Primary Outcome

Efficacy and/or safety in acute ischemic stroke

Limitations

Selection criteria limit the number of patients who can benefit
Further studies are needed to prove cost-effectiveness

Implication

Supports thrombectomy as standard adjunct for eligible acute ischemic stroke; confirms superiority in most RCTs.

Abstract

UNLABELLED: Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. OBJECTIVE: To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). METHOD: Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). RESULTS: From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. CONCLUSION: Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

Discussion

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Cite This Study

Ferri et al. (2015) conducted a systematic review in Acute ischemic stroke. Endovascular thrombectomy plus standard treatment vs. Standard treatment alone was evaluated on Efficacy and/or safety in acute ischemic stroke. Endovascular thrombectomy combined with standard care showed superiority over standard care alone in 5 of 8 published RCTs for acute ischemic stroke.

synapsesocial.com/papers/6add440438e88aefb0a9fcf6 https://doi.org/10.1590/0004-282x20150182

View Full Paper

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Endovascular thrombectomy for the treatment of acute ischemic stroke

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Endovascular thrombectomy for the treatment of acute ischemic stroke

Key Points

Study Design

PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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