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Got It, Hide thisBadhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis. JAMA. 2015;314:1832-43.
In people with acute ischemic stroke affecting the front part of the brain, does a surgical procedure, “endovascular mechanical thrombectomy” (EMT) improve outcomes?
An ischemic stroke occurs when an artery to the brain is narrowed or blocked by a clot and blood is not able to reach part of the brain. More than 4 out of 5 strokes are ischemic. Symptoms of ischemic stroke include difficulty with language (understanding and speaking), vision problems, headache, difficulty walking, and paralysis or numbness.
Very fast treatment of a stroke is critical to success. Doctors can use medications given by mouth, into the bloodstream, or directly to the brain to break up a clot and restore blood flow. Intravenous tissue plasminogen activator (tPA) dissolves clots and improves recovery from strokes, but it can also cause bleeding in the brain. Endovascular mechanical thrombectomy (EMT) uses a small device inserted into the artery to break up or remove a clot.
The researchers did a systematic review based on studies available up to August 2015.
They found 8 randomized controlled trials with 2,423 people (average age 67 years; 53% were men).
Key features of the studies were:
The quality of evidence was moderate to high.
Compared with tPA alone, EMT:
Compared with tPA, EMT did not:
In people with acute ischemic stroke, endovascular mechanical thrombectomy improves functional independence but does not reduce risk of death compared with tPA. If someone is having a stroke, they need to get medical attention immediately—call 911.
Outcomes | Number of trials (number of people) | Rate of events with mechanical thrombectomy | Rate of events with tPA | Absolute effect of endovascular thrombectomy |
Revascularization (blood flow through the artery) at 24 hours | 4 trials (874 people) | 76% | 34% | About 42 more people out of 100 had blood flow through the blocked artery |
Functional independence at 90 days | 8 trials (2,387 people) | 45% | 32% | About 13 more people out of 100 were able to take care of themselves without help |
Death at 90 days | 8 trials (2,418 people) | 16% | 18% | No effect* |
Symptomatic intracranial hemorrhage (bleeding in the brain) at 90 days | 8 trials (2,422 people) | 5.7% | 5.1% | No effect* |