Key messages from scientific research that's ready to be acted on
Got It, Hide thisSardar P, Chatterjee S, Giri J, et al. Endovascular therapy for acute ischaemic stroke: a systematic review and meta-analysis of randomized trials. Eur Heart J. 2015;36:2373-80.
In people having an ischemic stroke, does adding endovascular therapy (a tube to remove the clot) to clot-busting drugs improve outcomes?
Stroke occurs when an artery supplying blood to part of the brain becomes blocked (“ischemic stroke”). People with strokes may have short-term or longer-term problems with such things as moving, talking, swallowing, or thinking. These problems are less likely or less severe if a stroke is treated quickly with a “clot-buster” (tissue plasminogen activator [tPA]), a drug that is injected to dissolve the clot. However, this treatment must be given within the first few hours after the onset of the stroke.
Some people may not be able to use clot-busting drugs (e.g., people with a high risk of bleeding).
Now there is a new treatment to be used in addition to a clot-buster: Endovascular therapy uses a catheter (a thin tube), threaded through an artery to the brain to get directly to clots and break them up or remove them using clot-busting drugs or small mechanical devices, such as a “stent retrievers.” At present, this procedure can only be done if the blocked artery is a larger one in the front part of the head. This treatment also needs to be done within the first few hours of stroke onset.
The reviewers did a systematic review, searching for studies that were published in English up to May 2015. They found 8 randomized controlled trials with 2,423 people (53% were men and more than 50% were 62 years of age or older).
The key features of the trials were:
Compared with IV clot-busting drugs alone, adding endovascular therapy:
In people having an ischemic stroke, adding endovascular therapy to IV clot-busting drugs within a few hours of the stroke improves their ability to manage on their own at 3 months after the stroke.
Outcomes | Number of trials (people) | Rate of events with EVT | Rate of events with clot-busting drugs alone | Absolute effect of EVT |
Independent functioning at 90 days | 8 trials (2,419 people) | 45% | 32% | About 13 more people out of 100 had independent functioning at 90 days (from as few as 4 to as many as 22) |
Death | 8 trials (2,419 people) | 16% | 17% | No difference in effect* |
Bleeding within the brain along with symptoms | 8 trials (2,423 people) | 5.1% | 4.8% | No difference in effect* |