Xuan Bai1, Jianting Qiu1, Yujie Wang2. 1. Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China. 2. Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang, 110016, People's Republic of China. wangyujie196508@163.com.
Abstract
BACKGROUND AND PURPOSE: This study investigated clinical outcomes after direct endovascular thrombectomy (EVT) compared to bridging therapy (EVT with prior intravenous alteplase) in acute stroke within 4.5 h after onset. METHODS: PubMed and Embase were searched for eligible randomized controlled trials. The primary outcome was the rates of neurological functional independence defined as modified Rankin scale score 0-2 at 90 days, whose non-inferiority margin was set at - 15%, - 10%, - 6.5%, - 5%, and - 1.3% for its risk difference (RD). RESULTS: We included six studies enrolling 2334 participants. The crude cumulative rates of functional independence were 49.0% with direct EVT vs 50.9% with bridging therapy, without significant difference (Odd ratio [OR] = 0.93, 95% confidence interval [CI] 0.79-1.09) between two groups, where the pooled RD was - 2% (95% CI - 6 to 2%) whose lower 95% CI bound fell within non-inferiority margins of - 15%, - 10%, -6.5%, but not - 5% and - 1.3%. Between the two groups, no significant difference was found in excellent function rate (30.2% vs 30.6%, OR = 0.99, 95% CI 0.82-1.18) with RD of 0% (95% CI - 3 to 4%), mortality rate (16.0% vs 15.0%, OR = 1.08, 95% CI 0.86-1.35) with RD of 1% (95% CI - 2 to 4%), and symptomatic intracranial hemorrhage rate (4.3% vs 5.0%, OR = 0.86, 95% CI 0.58-1.27) with RD of 0% (95% CI - 2 to 1%). CONCLUSIONS: No statistical difference was found in functional and safety outcomes between direct EVT and bridging therapy groups in acute stroke within 4.5 h after symptom onset. EVT alone was non-inferior to bridging therapy for several, but not the more stringent, non-inferiority margins.
BACKGROUND AND PURPOSE: This study investigated clinical outcomes after direct endovascular thrombectomy (EVT) compared to bridging therapy (EVT with prior intravenous alteplase) in acute stroke within 4.5 h after onset. METHODS: PubMed and Embase were searched for eligible randomized controlled trials. The primary outcome was the rates of neurological functional independence defined as modified Rankin scale score 0-2 at 90 days, whose non-inferiority margin was set at - 15%, - 10%, - 6.5%, - 5%, and - 1.3% for its risk difference (RD). RESULTS: We included six studies enrolling 2334 participants. The crude cumulative rates of functional independence were 49.0% with direct EVT vs 50.9% with bridging therapy, without significant difference (Odd ratio [OR] = 0.93, 95% confidence interval [CI] 0.79-1.09) between two groups, where the pooled RD was - 2% (95% CI - 6 to 2%) whose lower 95% CI bound fell within non-inferiority margins of - 15%, - 10%, -6.5%, but not - 5% and - 1.3%. Between the two groups, no significant difference was found in excellent function rate (30.2% vs 30.6%, OR = 0.99, 95% CI 0.82-1.18) with RD of 0% (95% CI - 3 to 4%), mortality rate (16.0% vs 15.0%, OR = 1.08, 95% CI 0.86-1.35) with RD of 1% (95% CI - 2 to 4%), and symptomatic intracranial hemorrhage rate (4.3% vs 5.0%, OR = 0.86, 95% CI 0.58-1.27) with RD of 0% (95% CI - 2 to 1%). CONCLUSIONS: No statistical difference was found in functional and safety outcomes between direct EVT and bridging therapy groups in acute stroke within 4.5 h after symptom onset. EVT alone was non-inferior to bridging therapy for several, but not the more stringent, non-inferiority margins.
Authors: Natalie E LeCouffe; Manon Kappelhof; Kilian M Treurniet; Leon A Rinkel; Agnetha E Bruggeman; Olvert A Berkhemer; Lennard Wolff; Henk van Voorst; Manon L Tolhuisen; Diederik W J Dippel; Aad van der Lugt; Adriaan C G M van Es; Jelis Boiten; Geert J Lycklama À Nijeholt; Koos Keizer; Rob A R Gons; Lonneke S F Yo; Robert J van Oostenbrugge; Wim H van Zwam; Bob Roozenbeek; H Bart van der Worp; Rob T H Lo; Ido R van den Wijngaard; Inger R de Ridder; Vincent Costalat; Caroline Arquizan; Robin Lemmens; Jelle Demeestere; Jeannette Hofmeijer; Jasper M Martens; Wouter J Schonewille; Jan-Albert Vos; Maarten Uyttenboogaart; Reinoud P H Bokkers; Julia H van Tuijl; Hans Kortman; Floris H B M Schreuder; Hieronymus D Boogaarts; Karlijn F de Laat; Lukas C van Dijk; Heleen M den Hertog; Boudewijn A A M van Hasselt; Paul J A M Brouwers; Tomas Bulut; Michel J M Remmers; Anouk van Norden; Farshad Imani; Anouk D Rozeman; Otto E H Elgersma; Philippe Desfontaines; Denis Brisbois; Yves Samson; Frédéric Clarençon; G Menno Krietemeijer; Alida A Postma; Pieter-Jan van Doormaal; René van den Berg; Anouk van der Hoorn; Ludo F M Beenen; Daan Nieboer; Hester F Lingsma; Bart J Emmer; Jonathan M Coutinho; Charles B L M Majoie; Yvo B W E M Roos Journal: N Engl J Med Date: 2021-11-11 Impact factor: 91.245
Authors: Peter J Mitchell; Bernard Yan; Leonid Churilov; Richard J Dowling; Steven J Bush; Andrew Bivard; Xiao Chuan Huo; Guoqing Wang; Shi Yong Zhang; Mai Duy Ton; Dennis J Cordato; Timothy J Kleinig; Henry Ma; Ronil V Chandra; Helen Brown; Bruce C V Campbell; Andrew K Cheung; Brendan Steinfort; Rebecca Scroop; Kendal Redmond; Ferdinand Miteff; Yan Liu; Dang Phuc Duc; Hal Rice; Mark W Parsons; Teddy Y Wu; Huy-Thang Nguyen; Geoffrey A Donnan; Zhong Rong Miao; Stephen M Davis Journal: Lancet Date: 2022-07-09 Impact factor: 202.731
Authors: Urs Fischer; Johannes Kaesmacher; Daniel Strbian; Omer Eker; Christoph Cognard; Patricia S Plattner; Lukas Bütikofer; Pasquale Mordasini; Sandro Deppeler; Vitor M Pereira; Jean François Albucher; Jean Darcourt; Romain Bourcier; Guillon Benoit; Chrysanthi Papagiannaki; Ozlem Ozkul-Wermester; Gerli Sibolt; Marjaana Tiainen; Benjamin Gory; Sébastien Richard; Jan Liman; Marielle Sophie Ernst; Marion Boulanger; Charlotte Barbier; Laura Mechtouff; Liqun Zhang; Gaultier Marnat; Igor Sibon; Omid Nikoubashman; Arno Reich; Arturo Consoli; Bertrand Lapergue; Marc Ribo; Alejandro Tomasello; Suzana Saleme; Francisco Macian; Solène Moulin; Paolo Pagano; Guillaume Saliou; Emmanuel Carrera; Kevin Janot; María Hernández-Pérez; Raoul Pop; Lucie Della Schiava; Andreas R Luft; Michel Piotin; Jean Christophe Gentric; Aleksandra Pikula; Waltraud Pfeilschifter; Marcel Arnold; Adnan H Siddiqui; Michael T Froehler; Anthony J Furlan; René Chapot; Martin Wiesmann; Paolo Machi; Hans-Christoph Diener; Zsolt Kulcsar; Leo H Bonati; Claudio L Bassetti; Mikael Mazighi; David S Liebeskind; Jeffrey L Saver; Jan Gralla Journal: Lancet Date: 2022-07-09 Impact factor: 202.731