Mechanical Thrombectomy Improves Functional Outcomes Independent of Pretreatment with Intravenous Thrombolysis

Georgios Tsivgoulis, Aristeidis H. Katsanos, Dimitris Mavridis, Georgios Magoufis, Adam Arthur, Andrei Alexandrov

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background and Purpose - Endovascular intervention for emergent large-vessel occlusion (ELVO) has evolved rapidly during the past decade. The question of whether pretreatment with intravenous thrombolysis (IVT) has a significant impact on the functional outcome of patients with ELVO still remains unanswered. Methods - We conducted a systematic review and meta-analysis of all available randomized controlled trials evaluating the efficacy of endovascular therapy (ET) for acute ischemic stroke. We performed a mixed-effects subgroup analysis of the reported odds ratios on the association of ET (versus standard therapy) with 3-month functional outcome, stratified by pretreatment with IVT. Results - Six randomized controlled trials were included, comprising 1916 total patients (49.1% receiving ET with IVT pretreatment and 5.6% receiving ET without IVT pretreatment). In the subgroup analysis, ET was associated with a higher likelihood of better 3-month functional outcome in both the subgroup of patients with (odds ratio=1.83; 95% confidence interval, 1.37-2.44; P<0.001) and without (odds ratio=2.47; 95% confidence interval, 1.32-4.63; P=0.001) pretreatment with IVT. We documented no significant effect of IVT pretreatment on the 3-month functional outcome of patients with ELVO undergoing ET, suggesting that ET is effective in all patients with ELVO. Heterogeneity was documented in the IVT pretreatment subgroup (I2=68.3%; P for Cochran Q=0.014), but not in the subgroup that did not receive IVT pretreatment (I2=0%, P for Cochran Q=0.927). The risk of bias was considered to be generally low in the qualitative assessment of the included trials. Conclusions - Our observation provides evidence and further reassurance to stroke clinicians regarding the efficacy of ET in ELVO independent of pretreatment with IVT.

Original languageEnglish (US)
Pages (from-to)1661-1664
Number of pages4
JournalStroke
Volume47
Issue number6
DOIs
StatePublished - Jun 1 2016

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Thrombectomy
Therapeutics
Odds Ratio
Randomized Controlled Trials
Stroke
Confidence Intervals
Meta-Analysis
Observation

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Mechanical Thrombectomy Improves Functional Outcomes Independent of Pretreatment with Intravenous Thrombolysis. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Mavridis, Dimitris; Magoufis, Georgios; Arthur, Adam; Alexandrov, Andrei.

In: Stroke, Vol. 47, No. 6, 01.06.2016, p. 1661-1664.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Mavridis, Dimitris ; Magoufis, Georgios ; Arthur, Adam ; Alexandrov, Andrei. / Mechanical Thrombectomy Improves Functional Outcomes Independent of Pretreatment with Intravenous Thrombolysis. In: Stroke. 2016 ; Vol. 47, No. 6. pp. 1661-1664.
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abstract = "Background and Purpose - Endovascular intervention for emergent large-vessel occlusion (ELVO) has evolved rapidly during the past decade. The question of whether pretreatment with intravenous thrombolysis (IVT) has a significant impact on the functional outcome of patients with ELVO still remains unanswered. Methods - We conducted a systematic review and meta-analysis of all available randomized controlled trials evaluating the efficacy of endovascular therapy (ET) for acute ischemic stroke. We performed a mixed-effects subgroup analysis of the reported odds ratios on the association of ET (versus standard therapy) with 3-month functional outcome, stratified by pretreatment with IVT. Results - Six randomized controlled trials were included, comprising 1916 total patients (49.1{\%} receiving ET with IVT pretreatment and 5.6{\%} receiving ET without IVT pretreatment). In the subgroup analysis, ET was associated with a higher likelihood of better 3-month functional outcome in both the subgroup of patients with (odds ratio=1.83; 95{\%} confidence interval, 1.37-2.44; P<0.001) and without (odds ratio=2.47; 95{\%} confidence interval, 1.32-4.63; P=0.001) pretreatment with IVT. We documented no significant effect of IVT pretreatment on the 3-month functional outcome of patients with ELVO undergoing ET, suggesting that ET is effective in all patients with ELVO. Heterogeneity was documented in the IVT pretreatment subgroup (I2=68.3{\%}; P for Cochran Q=0.014), but not in the subgroup that did not receive IVT pretreatment (I2=0{\%}, P for Cochran Q=0.927). The risk of bias was considered to be generally low in the qualitative assessment of the included trials. Conclusions - Our observation provides evidence and further reassurance to stroke clinicians regarding the efficacy of ET in ELVO independent of pretreatment with IVT.",
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AB - Background and Purpose - Endovascular intervention for emergent large-vessel occlusion (ELVO) has evolved rapidly during the past decade. The question of whether pretreatment with intravenous thrombolysis (IVT) has a significant impact on the functional outcome of patients with ELVO still remains unanswered. Methods - We conducted a systematic review and meta-analysis of all available randomized controlled trials evaluating the efficacy of endovascular therapy (ET) for acute ischemic stroke. We performed a mixed-effects subgroup analysis of the reported odds ratios on the association of ET (versus standard therapy) with 3-month functional outcome, stratified by pretreatment with IVT. Results - Six randomized controlled trials were included, comprising 1916 total patients (49.1% receiving ET with IVT pretreatment and 5.6% receiving ET without IVT pretreatment). In the subgroup analysis, ET was associated with a higher likelihood of better 3-month functional outcome in both the subgroup of patients with (odds ratio=1.83; 95% confidence interval, 1.37-2.44; P<0.001) and without (odds ratio=2.47; 95% confidence interval, 1.32-4.63; P=0.001) pretreatment with IVT. We documented no significant effect of IVT pretreatment on the 3-month functional outcome of patients with ELVO undergoing ET, suggesting that ET is effective in all patients with ELVO. Heterogeneity was documented in the IVT pretreatment subgroup (I2=68.3%; P for Cochran Q=0.014), but not in the subgroup that did not receive IVT pretreatment (I2=0%, P for Cochran Q=0.927). The risk of bias was considered to be generally low in the qualitative assessment of the included trials. Conclusions - Our observation provides evidence and further reassurance to stroke clinicians regarding the efficacy of ET in ELVO independent of pretreatment with IVT.

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