Georgios Tsivgoulis1, Aristeidis H Katsanos2, Dimitris Mavridis2, Georgios Magoufis2, Adam Arthur2, Andrei V Alexandrov2. 1. From the Department of Neurology (G.T., A.V.A.) and Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute (A.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Athens, Greece (G.T., A.H.K.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic (G.T.); and Department of Neurology, School of Medicine (A.H.K.), Department of Primary Education (D.M.), and Department of Hygiene and Epidemiology, School of Medicine (D.M.), University of Ioannina, Ioannina, Greece; Stroke Unit, Metropolitan Hospital, Piraeus, Greece (G.M.). tsivgoulisgiorg@yahoo.gr. 2. From the Department of Neurology (G.T., A.V.A.) and Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute (A.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Athens, Greece (G.T., A.H.K.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic (G.T.); and Department of Neurology, School of Medicine (A.H.K.), Department of Primary Education (D.M.), and Department of Hygiene and Epidemiology, School of Medicine (D.M.), University of Ioannina, Ioannina, Greece; Stroke Unit, Metropolitan Hospital, Piraeus, Greece (G.M.).
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 (I(2)=68.3%; P for Cochran Q=0.014), but not in the subgroup that did not receive IVT pretreatment (I(2)=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.
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 (I(2)=68.3%; P for Cochran Q=0.014), but not in the subgroup that did not receive IVT pretreatment (I(2)=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.
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Ramin Zand; Vijay K Sharma; Martin Köhrmann; Sotirios Giannopoulos; Efthymios Dardiotis; Anne W Alexandrov; Panayiotis D Mitsias; Peter D Schellinger; Andrei V Alexandrov Journal: J Neurol Date: 2017-05-26 Impact factor: 4.849
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