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Efficacy and safety of endovascular treatment versus intravenous thrombolysis for acute ischemic stroke: a meta-analysis of randomized controlled trials.

Lin C, Li N, Wang K, Zhao X, Li BQ, Sun L, Lin YX, Fan JM, Zhang M, Sun HC - PLoS ONE (2013)

Bottom Line: ET and IVT were associated with similar good (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) and excellent (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) outcome.For additional end points, ET was not associated with increased occurrence of symptomatic hemorrhage (6.25% vs. 6.22%; OR=1.03; 95% CI, 0.62 to 1.69; P=0.91;), or all-cause mortality (18.45% vs. 17.35%; OR=1.00; 95% CI, 0.73 to 1.39; P=0.99;).Formal meta-analysis indicates that there are similar safety outcomes and functional independence with endovascular therapy and intravenous thrombolysis for acute ischemic stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China.

ABSTRACT

Background and purpose: Although endovascular therapy (ET) is increasingly used in patients with moderate to severe acute ischemic stroke, its efficacy and safety remains controversial. We performed a meta-analysis aiming to compare the benefits and safety of endovascular treatment and intravenous thrombolysis in the treatment of acute ischemic stroke.

Methods: We systematically searched PubMed, Embase, Science direct and Springer unitil July, 2013. The primary outcomes included good outcome (mRS ≤ 2) and excellent outcome (mRS ≤ 1) at 90 days or at trial end point. Secondary outcomes were occurrence of symptomatic hemorrhage and all-cause mortality.

Results: Using a prespecified search strategy, 5 RCTs with 1106 patients comparing ET and intravenous thrombolysis (IVT) were included in the meta-analysis. ET and IVT were associated with similar good (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) and excellent (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) outcome. For additional end points, ET was not associated with increased occurrence of symptomatic hemorrhage (6.25% vs. 6.22%; OR=1.03; 95% CI, 0.62 to 1.69; P=0.91;), or all-cause mortality (18.45% vs. 17.35%; OR=1.00; 95% CI, 0.73 to 1.39; P=0.99;).

Conclusions: Formal meta-analysis indicates that there are similar safety outcomes and functional independence with endovascular therapy and intravenous thrombolysis for acute ischemic stroke.

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Related in: MedlinePlus

Primary Outcomes of patients treated with Endovascular Therapy and Intravenous Thrombolysis after acute ischemic stroke.(A) Forest plot of RR and 95% CI for the occurrence of good outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis. (B) Forest plot of RR and 95% CI for the occurrence of excellent outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis.
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pone-0077849-g002: Primary Outcomes of patients treated with Endovascular Therapy and Intravenous Thrombolysis after acute ischemic stroke.(A) Forest plot of RR and 95% CI for the occurrence of good outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis. (B) Forest plot of RR and 95% CI for the occurrence of excellent outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis.

Mentions: Four studies presented information on good outcome at follow-up (Figure 2A), and three on excellent outcome (Figure 2B). No statistically significant increase of good clinical outcomes (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) or excellent clinical outcomes were found following endovascular therapy (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) (Figure 2).


Efficacy and safety of endovascular treatment versus intravenous thrombolysis for acute ischemic stroke: a meta-analysis of randomized controlled trials.

Lin C, Li N, Wang K, Zhao X, Li BQ, Sun L, Lin YX, Fan JM, Zhang M, Sun HC - PLoS ONE (2013)

Primary Outcomes of patients treated with Endovascular Therapy and Intravenous Thrombolysis after acute ischemic stroke.(A) Forest plot of RR and 95% CI for the occurrence of good outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis. (B) Forest plot of RR and 95% CI for the occurrence of excellent outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3814965&req=5

pone-0077849-g002: Primary Outcomes of patients treated with Endovascular Therapy and Intravenous Thrombolysis after acute ischemic stroke.(A) Forest plot of RR and 95% CI for the occurrence of good outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis. (B) Forest plot of RR and 95% CI for the occurrence of excellent outcome in patients assigned to Endovascular Therapy and Intravenous Thrombolysis.
Mentions: Four studies presented information on good outcome at follow-up (Figure 2A), and three on excellent outcome (Figure 2B). No statistically significant increase of good clinical outcomes (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) or excellent clinical outcomes were found following endovascular therapy (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) (Figure 2).

Bottom Line: ET and IVT were associated with similar good (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) and excellent (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) outcome.For additional end points, ET was not associated with increased occurrence of symptomatic hemorrhage (6.25% vs. 6.22%; OR=1.03; 95% CI, 0.62 to 1.69; P=0.91;), or all-cause mortality (18.45% vs. 17.35%; OR=1.00; 95% CI, 0.73 to 1.39; P=0.99;).Formal meta-analysis indicates that there are similar safety outcomes and functional independence with endovascular therapy and intravenous thrombolysis for acute ischemic stroke.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China.

ABSTRACT

Background and purpose: Although endovascular therapy (ET) is increasingly used in patients with moderate to severe acute ischemic stroke, its efficacy and safety remains controversial. We performed a meta-analysis aiming to compare the benefits and safety of endovascular treatment and intravenous thrombolysis in the treatment of acute ischemic stroke.

Methods: We systematically searched PubMed, Embase, Science direct and Springer unitil July, 2013. The primary outcomes included good outcome (mRS ≤ 2) and excellent outcome (mRS ≤ 1) at 90 days or at trial end point. Secondary outcomes were occurrence of symptomatic hemorrhage and all-cause mortality.

Results: Using a prespecified search strategy, 5 RCTs with 1106 patients comparing ET and intravenous thrombolysis (IVT) were included in the meta-analysis. ET and IVT were associated with similar good (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) and excellent (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) outcome. For additional end points, ET was not associated with increased occurrence of symptomatic hemorrhage (6.25% vs. 6.22%; OR=1.03; 95% CI, 0.62 to 1.69; P=0.91;), or all-cause mortality (18.45% vs. 17.35%; OR=1.00; 95% CI, 0.73 to 1.39; P=0.99;).

Conclusions: Formal meta-analysis indicates that there are similar safety outcomes and functional independence with endovascular therapy and intravenous thrombolysis for acute ischemic stroke.

Show MeSH
Related in: MedlinePlus