Jun Zhang1,2,3,4, Cong Yuan1,2,3,4, Xinyu Deng1,2,3,4, Qiang Yuan1,2,3,4, Meihua Wang1,2,3,4, Pengfei Fu1,2,3,4, Jiang Fang1,2,3,4, Zhuoying Du5,6,7,8, Jin Hu9,10,11,12. 1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Urumqi Middle Road, Jing'an District, Shanghai, 200040, China. 2. Neurosurgical Institute of Fudan University, Shanghai, 200040, China. 3. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. 4. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. 5. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Urumqi Middle Road, Jing'an District, Shanghai, 200040, China. zdu10@fudan.edu.cn. 6. Neurosurgical Institute of Fudan University, Shanghai, 200040, China. zdu10@fudan.edu.cn. 7. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. zdu10@fudan.edu.cn. 8. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. zdu10@fudan.edu.cn. 9. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Urumqi Middle Road, Jing'an District, Shanghai, 200040, China. hujin_dana@126.com. 10. Neurosurgical Institute of Fudan University, Shanghai, 200040, China. hujin_dana@126.com. 11. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China. hujin_dana@126.com. 12. Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, 200040, China. hujin_dana@126.com.
Abstract
OBJECTIVE: The current meta-analysis aimed to investigate the efficacy and safety of direct endovascular treatment (EVT) and bridging therapy (EVT with prior intravenous thrombolysis (IVT)) in patients with acute anterior circulation large vessel occlusion (LVO) stroke. METHODS: This meta-analysis followed PRISMA guidelines. Eligible RCTs were identified through a systemic search of electronic databases (PubMed, Ovid, Web of Science, and Cochrane Library) from the inception dates to January 10, 2022. The pooled analyses were performed using RevMan 5.3 software. The primary outcome was functional outcome on the modified Rankin Scale (mRS) (range 0 to 5) at 90 days. The secondary outcomes included successful reperfusion, intracranial hemorrhage, and mortality (mRS 6) within 90 days. RESULTS: A total of 4 RCTs involving 1633 patients were finally included. Findings of pooled analyses indicated that neither the primary outcomes (no disability (mRS 0), no significant disability despite some symptoms (mRS 1), slight disability (mRS 2), moderate disability (mRS 3), moderately severe disability (mRS 4), severe disability (mRS 5), excellent outcome (mRS 0-1), functional independence outcome (mRS 0-2), and poor outcome (mRS 3-5)) nor the secondary outcomes (successful reperfusion, intracranial hemorrhage, and mortality) in the EVT groups were not statistically significant compared with the IVT plus EVT groups (P > 0.05). In addition, the outcomes of sensitivity analysis implied that the findings of meta-analysis were credible. CONCLUSIONS: Among patients with acute ischemic stroke due to LVO of anterior circulation, EVT alone yielded efficacy and safety outcomes similar to IVT plus EVT.
OBJECTIVE: The current meta-analysis aimed to investigate the efficacy and safety of direct endovascular treatment (EVT) and bridging therapy (EVT with prior intravenous thrombolysis (IVT)) in patients with acute anterior circulation large vessel occlusion (LVO) stroke. METHODS: This meta-analysis followed PRISMA guidelines. Eligible RCTs were identified through a systemic search of electronic databases (PubMed, Ovid, Web of Science, and Cochrane Library) from the inception dates to January 10, 2022. The pooled analyses were performed using RevMan 5.3 software. The primary outcome was functional outcome on the modified Rankin Scale (mRS) (range 0 to 5) at 90 days. The secondary outcomes included successful reperfusion, intracranial hemorrhage, and mortality (mRS 6) within 90 days. RESULTS: A total of 4 RCTs involving 1633 patients were finally included. Findings of pooled analyses indicated that neither the primary outcomes (no disability (mRS 0), no significant disability despite some symptoms (mRS 1), slight disability (mRS 2), moderate disability (mRS 3), moderately severe disability (mRS 4), severe disability (mRS 5), excellent outcome (mRS 0-1), functional independence outcome (mRS 0-2), and poor outcome (mRS 3-5)) nor the secondary outcomes (successful reperfusion, intracranial hemorrhage, and mortality) in the EVT groups were not statistically significant compared with the IVT plus EVT groups (P > 0.05). In addition, the outcomes of sensitivity analysis implied that the findings of meta-analysis were credible. CONCLUSIONS: Among patients with acute ischemic stroke due to LVO of anterior circulation, EVT alone yielded efficacy and safety outcomes similar to IVT plus EVT.
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Authors: Mayank Goyal; Andrew M Demchuk; Bijoy K Menon; Muneer Eesa; Jeremy L Rempel; John Thornton; Daniel Roy; Tudor G Jovin; Robert A Willinsky; Biggya L Sapkota; Dar Dowlatshahi; Donald F Frei; Noreen R Kamal; Walter J Montanera; Alexandre Y Poppe; Karla J Ryckborst; Frank L Silver; Ashfaq Shuaib; Donatella Tampieri; David Williams; Oh Young Bang; Blaise W Baxter; Paul A Burns; Hana Choe; Ji-Hoe Heo; Christine A Holmstedt; Brian Jankowitz; Michael Kelly; Guillermo Linares; Jennifer L Mandzia; Jai Shankar; Sung-Il Sohn; Richard H Swartz; Philip A Barber; Shelagh B Coutts; Eric E Smith; William F Morrish; Alain Weill; Suresh Subramaniam; Alim P Mitha; John H Wong; Mark W Lowerison; Tolulope T Sajobi; Michael D Hill Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
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