In the Journals

Mechanical thrombectomy yields improved functional outcomes in acute ischemic stroke

Mechanical thrombectomy after usual care was associated with improved functional outcomes and relative safety compared with usual care alone in patients with acute ischemic stroke due to large artery occlusion, according to a recent meta-analysis.

Researchers identified nine trials — ESCAPE, EXTEND-IA, IMS III, MR CLEAN, MR RESCUE, REVASCAT, SWIFT PRIME — comprising 2,140 patients with acute ischemic stroke randomized to usual care (ie, IV thrombolysis) with or without mechanical thrombectomy using available devices.

The primary outcome was good functional outcome at 90 days (modified Rankin scale, 0-2). Secondary efficacy outcomes included all-cause mortality, excellent functional outcome (modified Rankin scale, 0-1), fair functional outcome and recanalization.

“Because this field has undergone rapid development, the clinical utility of these devices for reducing mortality and morbidity in acute ischemic stroke remains uncertain,” Islam Y. Elgendy, MD, from the department of medicine at University of Florida, Gainesville, and colleagues wrote in the Journal of the American College of Cardiology.

According to the findings, patients who received mechanical thrombectomy after usual care had a greater prevalence of good functional outcome (43.7% vs. 30.9%; RR = 1.45; 95% CI, 1.22-1.72; P < .0001) and excellent functional outcome (26.3% vs. 15.5%; RR = 1.67; 95% CI, 1.27-2.19; P < .0001).

The researchers also observed a trend toward reduced all-cause mortality with mechanical thrombectomy after usual care (RR = 0.86; 95% CI, 0.72-1.02; P = .09). The risk for symptomatic intracranial hemorrhage was similar with either treatment strategy (RR = 1.06; 95% CI, 0.73-1.55; P = .76).

In six trials that reported recanalization rates, mechanical thrombectomy was linked with improved recanalization (66.6% vs. 39.2%; RR = 1.57; 95% CI, 1.11-2.23; P = .01).

Both treatment strategies were associated with similar risk for symptomatic intracranial hemorrhage (5.1% vs. 5%; RR = 1.06; 95% CI, 0.73-1.55; P = .76). Risk for recurrent stroke at 90 days was increased with mechanical thrombectomy (5% vs. 2.8%; RR = 1.97; 95% CI, 0.64-6.03; P = .24), according to the findings.

“IV thrombolysis remains the cornerstone for acute ischemic stroke management; however, less than 30% of eligible patients receive intravenous thrombolysis within the recommended time window,” the researchers concluded. “Although mechanical thrombectomy is beneficial, this procedure requires specialized centers of excellence; therefore, the widespread application of this therapy for ischemic stroke patients will likely remain limited for the foreseeable future.” – by Jennifer Byrne

Disclosure: See the full study for a list of the authors’ relevant financial disclosures.

Mechanical thrombectomy after usual care was associated with improved functional outcomes and relative safety compared with usual care alone in patients with acute ischemic stroke due to large artery occlusion, according to a recent meta-analysis.

Researchers identified nine trials — ESCAPE, EXTEND-IA, IMS III, MR CLEAN, MR RESCUE, REVASCAT, SWIFT PRIME — comprising 2,140 patients with acute ischemic stroke randomized to usual care (ie, IV thrombolysis) with or without mechanical thrombectomy using available devices.

The primary outcome was good functional outcome at 90 days (modified Rankin scale, 0-2). Secondary efficacy outcomes included all-cause mortality, excellent functional outcome (modified Rankin scale, 0-1), fair functional outcome and recanalization.

“Because this field has undergone rapid development, the clinical utility of these devices for reducing mortality and morbidity in acute ischemic stroke remains uncertain,” Islam Y. Elgendy, MD, from the department of medicine at University of Florida, Gainesville, and colleagues wrote in the Journal of the American College of Cardiology.

According to the findings, patients who received mechanical thrombectomy after usual care had a greater prevalence of good functional outcome (43.7% vs. 30.9%; RR = 1.45; 95% CI, 1.22-1.72; P < .0001) and excellent functional outcome (26.3% vs. 15.5%; RR = 1.67; 95% CI, 1.27-2.19; P < .0001).

The researchers also observed a trend toward reduced all-cause mortality with mechanical thrombectomy after usual care (RR = 0.86; 95% CI, 0.72-1.02; P = .09). The risk for symptomatic intracranial hemorrhage was similar with either treatment strategy (RR = 1.06; 95% CI, 0.73-1.55; P = .76).

In six trials that reported recanalization rates, mechanical thrombectomy was linked with improved recanalization (66.6% vs. 39.2%; RR = 1.57; 95% CI, 1.11-2.23; P = .01).

Both treatment strategies were associated with similar risk for symptomatic intracranial hemorrhage (5.1% vs. 5%; RR = 1.06; 95% CI, 0.73-1.55; P = .76). Risk for recurrent stroke at 90 days was increased with mechanical thrombectomy (5% vs. 2.8%; RR = 1.97; 95% CI, 0.64-6.03; P = .24), according to the findings.

“IV thrombolysis remains the cornerstone for acute ischemic stroke management; however, less than 30% of eligible patients receive intravenous thrombolysis within the recommended time window,” the researchers concluded. “Although mechanical thrombectomy is beneficial, this procedure requires specialized centers of excellence; therefore, the widespread application of this therapy for ischemic stroke patients will likely remain limited for the foreseeable future.” – by Jennifer Byrne

Disclosure: See the full study for a list of the authors’ relevant financial disclosures.