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Title: Direct endovascular thrombectomy and bridging strategies for acute ischemic stroke: a network meta-analysis.
Austin Authors: Phan, Kevin;Dmytriw, Adam A;Lloyd, Declan;Maingard, Julian M;Kok, Hong Kuan;Chandra, Ronil V;Brooks, Duncan Mark ;Thijs, Vincent N ;Moore, Justin M;Chiu, Albert Ho Yuen;Selim, Magdy;Goyal, Mayank;Pereira, Vitor Mendes;Thomas, Ajith J;Hirsch, Joshua A;Asadi, Hamed ;Wang, Nelson
Affiliation: Diagnostic and Interventional Neuroradiology, University of Calgary, Calgary, Alberta, Canada
Massachusetts General Hospital, Boston, Massachusetts, USA
NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia
Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
Neurosurgery Service, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Division of Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Interventional Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Issue Date: 5-Oct-2018
Date: 2018-10-05
Publication information: Journal of neurointerventional surgery 2019; 11(5): 443-449
Abstract: The present Bayesian network meta-analysis aimed to compare the various strategies for acute ischemic stroke: direct endovascular thrombectomy within the thrombolysis window in patients with no contraindications to thrombolysis (DEVT); (2) direct endovascular thrombectomy secondary to contraindications to thrombolysis (DEVTc); (3) endovascular thrombectomy in addition to thrombolysis (IVEVT); and (4) thrombolysis without thrombectomy (IVT). Six electronic databases were searched from their dates of inception to May 2017 to identify randomized controlled trials (RCTs) comparing IVT versus IVEVT, and prospective registry studies comparing IVEVT versus DEVT or IVEVT versus DEVTc. Network meta-analyses were performed using ORs and 95% CIs as the summary statistic. We identified 12 studies (5 RCTs, 7 prospective cohort) with a total of 3161 patients for analysis. There was no significant difference in good functional outcome at 90 days (modified Rankin Scale score ≤2) between DEVT and IVEVT. There was no significant difference in mortality between all treatment groups. DEVT was associated with a 49% reduction in intracranial hemorrhage (ICH) compared with IVEVT (OR 0.51; 95% CI 0.33 to 0.79), due to reduction in rates of asymptomatic ICH (OR 0.47; 95% CI 0.29 to 0.76). Patients treated with DEVT had higher rates of reperfusion compared with IVEVT (OR 1.73; 95% CI 1.04 to 2.94). To our knowledge, this is the first network meta-analysis to be performed in the era of contemporary mechanical thrombectomy comparing DEVT and DEVTc. Our analysis suggests the addition of thrombolysis prior to thrombectomy for large vessel occlusions may not be associated with improved outcomes.
DOI: 10.1136/neurintsurg-2018-014260
ORCID: 0000-0002-6614-8417
Journal: Journal of neurointerventional surgery
PubMed URL: 30291209
Type: Journal Article
Subjects: Stroke
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