No reduction in intracranial hemorrhage risks, however, compared with standard medical therapy
Endovascular thrombectomy improved survival outcomes in the first 90 days following acute ischemic stroke, but had little effect on intracranial hemorrhage when compared with standard medical therapy, a meta-analysis found.
Compared with medical therapy, endovascular thrombectomy significantly lowered the risk of 90-day mortality by 3.7% (18.7% vs 15.0%; P=0.03), reported Georg Wolff, MD, of Heinrich-Heine-University in Germany, and colleagues in JAMA Neurology.
However, the risk of intracranial hemorrhage did not differ for patients treated with medical therapy versus those who had endovascular thrombectomy (4.0% vs 4.2%; P=0.65), the researchers found.
The 2018 American Stroke Association (ASA)/American Heart Association (AHA) guidelines for acute ischemic stroke suggest that endovascular thrombectomy benefits functional outcomes, the investigators noted.
There are a number of "striking" similarities between the management of myocardial infarction and acute ischemic stroke. For both events, intravenous thrombolysis was established first to better clinical outcomes, and later was considered inferior to interventional methods of primary percutaneous coronary intervention. Unlike for intravenous thrombolysis for treatment of myocardial infarction, however, improved survival following acute ischemic stroke was not evident in either short-term or long-term follow-up, the researchers emphasized.
"We cannot help but see the parallels: endovascular strategies may well turn out to be as successful in AIS [acute ischemic stroke] as in myocardial infarction," the researchers wrote.
The meta-analysis highlighted the benefit in stroke mortality when using this therapy in appropriately selected patients, noted Shreyansh Shah, MD, of Duke University Health System in Durham, North Carolina, who was not involved in the study. "Now the next step the stroke community needs to take is to improve access to this life-saving therapy. Only then would we be able to realize the potential of this therapy -- that is, to see a reduction in stroke mortality at the population level," Shah told MedPage Today.
Wolff's group reviewed 10 trials that included 2,313 patients. Singular study information was incorporated using a random-effects model to calculate summary statistics of risk ratios along with 95% confidence intervals and the Cochran-Mantel-Haenszel method. Information abstractions were done by two independent investigators and verified by four others.
Trials were excluded from the meta-analysis for using endovascular thrombectomy devices in only a minority of patients and having the wrong comparators. Inclusion criteria were ASA/AHA guidelines-related randomized clinical trials evaluating medical therapy compared with endovascular thrombectomy.
Other data showed similar trends in late-window trials as the relative risk was 0.76 (P=0.38) and early-window trials only as the relative risk was 0.83 (P =0.06), the team noted.
Study limitations, Wolff and co-authors noted, included bias due to trials ending prematurely and protocol heterogeneity.
Wolff was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf.
Source Reference: Lin Y, et al "Endovascular thrombectomy as a means to improve survival in acute ischemic stroke a meta-analysis" JAMA Neurol 2019; DOI: 10.1001/jamaneurol.2019.0525.
Read the original article on Medpage Today: Clot-Picking in Stroke Scores Meta-Analysis Win