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

• Published in: PloS one Vol. 8; no. 10; p. e77849
• Main Authors: Lin, Chao, Li, Nan, Wang, Kang, Zhao, Xin, Li, Bai-Qiang, Sun, Lei, Lin, Yi-Xing, Fan, Jie-Mei, Zhang, Miao, Sun, Hai-Chen
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2013; Public Library of Science (PLoS)
• Subjects: Brain Ischemia - therapy; Cardiovascular system; Clinical trials; Councils; Edema; Endovascular Procedures; Feasibility studies; Fibrinolytic Agents - therapeutic use; Heart attacks; Hemorrhage; Humans; Injections, Intravenous; Intravenous administration; Ischemia; Medical ethics; Meta-analysis; Mortality; Neurosurgery; Patients; Randomized Controlled Trials as Topic; Safety; Source studies; Stroke; Stroke - therapy; Therapy; Thrombolysis; Thrombolytic Therapy; Treatment Outcome; Urology; Veins & arteries; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0077849

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