Pharmacologie cardiovasculaire : libre accès

Abstrait

Endovascular Treatment over Standard Medical Therapy in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials

Paolo Cerrone and Carmine Marini

Background: Endovascular treatment plays a continuously expanding role in the treatment of acute ischemic stroke. Several randomized controlled clinical trials evaluating possible benefits of endovascular therapy were conducted. From these trials emerged conflicting results. The aim of this study was to evaluate the efficacy of endovascular treatment over standard therapy in acute ischemic stroke. Methods: We searched in PubMed and EMBASE databases from the date of inception until 2015/07/31. The primary outcome was the functional neurological outcome at 90 days measured with modified Rankin Score ≤ 2. Secondary outcomes were partial or complete recanalization, assessed with modified arterial occlusive lesion, thrombolysis in myocardial infarction or thrombolysis in cerebral infarction scores of 2-3 and mortality. Safety outcome was Symptomatic Intracranial Hemorrhage (SICH). Data were pooled in the control and intervention groups, and odds ratios were calculated with 95% interval confidence. Statistical heterogeneity was evaluated with the χ2 Mantel-Haenszel method and Iâ�� method. A p value <0.05 was considered statistically significant. Heterogeneity was considered significant for P values <0.10. Results: 12 trials were included with 2725 participants. Compared with standard therapy, endovascular treatment significantly improved the outcome at 90 days (OR: 1.77; 95% CI: 1.51-2.08). This result was affected by a significative heterogeneity. After a sensitivity analysis, excluding the trials in which the demonstration of large vessel occlusion was not an inclusion criterion, primary outcome was improved in the intervention group (OR: 2.05 95% CI: 1.70-2.46), with non-significant heterogeneity. The recanalization rate was higher and mortality was lower in the intervention groups, but these differences were not significant. The proportion of SICH was marginally higher in the intervention groups, again without any statistical significance. Conclusion: Endovascular treatment for acute ischemic stroke ensures a significant increase of patients with favorable outcome compared with standard therapy in the absence of risk. Vascular studies before treatment are mandatory.