Background

Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta-analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed.

Aim

To perform a systematic review and a meta-analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke.

Summary of review

Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0–2) [odds ratio 1·56 (1·32–1·85), P < 0·00001]. There was a tendency toward decreased mortality [odds ratio 0·84 (0·67–1·05), P = 0·12], and symptomatic intracerebral hemorrhage was not increased [odds ratio 1·03 (0·71–1·49), P = 0·88] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 2·23 (1·77–2·81, P < 0·00001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial.

Conclusions

There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.

中文翻译：

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血管内血栓切除术与急性缺血性中风最佳药物治疗的随机对照试验的系统回顾和荟萃分析

背景

涉及大血管闭塞的急性缺血性中风通常在静脉溶栓治疗后很难再通。最近的研究表明，与单独的最佳医疗管理相比，血管内治疗的再通率更高，预后良好。一项系统回顾和荟萃分析调查了所有血管内血栓切除术随机对照试验的益处，其中至少 25% 的患者接受血栓切除装置治疗急性缺血性中风，与最佳药物治疗相比，尚未进行。

目的

进行系统评价和荟萃分析，评估血管内血栓切除术与治疗急性缺血性中风的最佳医疗护理的有效性。

审查摘要

我们的检索确定了 437 篇出版物，其中 8 项研究（总共 2423 名患者）符合纳入标准。总体而言，血管内血栓切除术与改善功能结果相关（改良Rankin量表0-2）[比值比1·56（1·32–1·85），P <0·00001]。死亡率呈下降趋势[比值比 0·84 (0·67–1·05)，P = 0·12]，而有症状的脑出血并未增加[比值比 1·03 (0·71–1·1) 49），P = 0·88]与单独最佳医疗管理相比。当每项试验中超过 50% 的病例使用新一代血栓切除装置时，良好功能结果的比值比增加至 2·23 (1·77–2·81，P < 0·00001)。

结论

有明确的证据表明，与标准医疗护理相比，血管内血栓切除术可改善功能独立性，这表明对于符合条件的患者，血管内血栓切除术应被视为与溶栓并列的标准有效治疗方法。