Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis
Mechanical thrombectomy (MT) has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS). Few studies have investigated long-term outcomes for AIS treated with MT. Therefore, a pooled meta-analysis using data from randomized clinical trials (RCT) was performed t...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1155/2019/7403104 |
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| author | David J. McCarthy Anthony Diaz Dallas L. Sheinberg Brian Snelling Evan M. Luther Stephanie H. Chen Dileep R. Yavagal Eric C. Peterson Robert M. Starke |
| author_facet | David J. McCarthy Anthony Diaz Dallas L. Sheinberg Brian Snelling Evan M. Luther Stephanie H. Chen Dileep R. Yavagal Eric C. Peterson Robert M. Starke |
| author_sort | David J. McCarthy |
| collection | DOAJ |
| description | Mechanical thrombectomy (MT) has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS). Few studies have investigated long-term outcomes for AIS treated with MT. Therefore, a pooled meta-analysis using data from randomized clinical trials (RCT) was performed to assess for long-term clinical outcomes. A systematic literature search was conducted on 27 September 2017, by searching the English literature in the Cochrane Library, MEDLINE, and Embase for RCTs investigating long-term outcomes (greater than standard 3-month timepoint) of endovascular intervention versus medical management for patients with AIS. The study was carried out according to PRISMA guidelines and random effects analysis was carried out to account for heterogeneity. Three trials were included: IMS III, MR CLEAN, and REVASCAT, comprising a total of 1,362 patients. Long-term clinical outcomes were available for 1-year follow-up in IMS III and REVASCAT and at 2 years in MR CLEAN. Functional independence at long-term follow-up favored endovascular stroke intervention (OR 1.51; p = 0.02). When stratified by LVO inclusion criteria, greater endovascular functional independence benefits were observed (OR 1.85; p = 0.0005). There was a significant difference between the 2 arms in favor of endovascular therapy for the quality of life at long-term follow-up (mean difference 0.11; p = 0.0002). No difference in mortality at long-term follow-up was observed (OR 0.82; p = 0.12). We conclude that endovascular therapy results in favorable outcomes at long-term follow-up for patients with acute ischemic stroke compared to standard medical treatment alone and that the 90-day timepoint offers a fair representation of the long-term outcomes. |
| format | Article |
| id | doaj-art-1da98c24d73e43fbb86b8c0af8a1eb59 |
| institution | Kabale University |
| issn | 2356-6140 1537-744X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-1da98c24d73e43fbb86b8c0af8a1eb592025-02-03T01:30:36ZengWileyThe Scientific World Journal2356-61401537-744X2019-01-01201910.1155/2019/74031047403104Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-AnalysisDavid J. McCarthy0Anthony Diaz1Dallas L. Sheinberg2Brian Snelling3Evan M. Luther4Stephanie H. Chen5Dileep R. Yavagal6Eric C. Peterson7Robert M. Starke8Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery and Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USADepartment of Neurological Surgery and Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USAMechanical thrombectomy (MT) has become the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke (AIS). Few studies have investigated long-term outcomes for AIS treated with MT. Therefore, a pooled meta-analysis using data from randomized clinical trials (RCT) was performed to assess for long-term clinical outcomes. A systematic literature search was conducted on 27 September 2017, by searching the English literature in the Cochrane Library, MEDLINE, and Embase for RCTs investigating long-term outcomes (greater than standard 3-month timepoint) of endovascular intervention versus medical management for patients with AIS. The study was carried out according to PRISMA guidelines and random effects analysis was carried out to account for heterogeneity. Three trials were included: IMS III, MR CLEAN, and REVASCAT, comprising a total of 1,362 patients. Long-term clinical outcomes were available for 1-year follow-up in IMS III and REVASCAT and at 2 years in MR CLEAN. Functional independence at long-term follow-up favored endovascular stroke intervention (OR 1.51; p = 0.02). When stratified by LVO inclusion criteria, greater endovascular functional independence benefits were observed (OR 1.85; p = 0.0005). There was a significant difference between the 2 arms in favor of endovascular therapy for the quality of life at long-term follow-up (mean difference 0.11; p = 0.0002). No difference in mortality at long-term follow-up was observed (OR 0.82; p = 0.12). We conclude that endovascular therapy results in favorable outcomes at long-term follow-up for patients with acute ischemic stroke compared to standard medical treatment alone and that the 90-day timepoint offers a fair representation of the long-term outcomes.http://dx.doi.org/10.1155/2019/7403104 |
| spellingShingle | David J. McCarthy Anthony Diaz Dallas L. Sheinberg Brian Snelling Evan M. Luther Stephanie H. Chen Dileep R. Yavagal Eric C. Peterson Robert M. Starke Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis The Scientific World Journal |
| title | Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis |
| title_full | Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis |
| title_fullStr | Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis |
| title_full_unstemmed | Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis |
| title_short | Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis |
| title_sort | long term outcomes of mechanical thrombectomy for stroke a meta analysis |
| url | http://dx.doi.org/10.1155/2019/7403104 |
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