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Mechanical removal of a thrombus in addition to usual care is associated with significantly better functional outcomes than usual care in patients who have experienced an acute ischemic stroke, according to a meta-analysis published online Nov. 30 in Journal of the American College of Cardiology.
The analysis of nine trials of usual care with or without mechanical thrombectomy in 2,410 patients showed that those undergoing mechanical thrombectomy had a 45% greater likelihood of achieving a good functional outcome and a 67% greater chance of excellent functional outcome, defined respectively as a modified Rankin scale score of 0-2 or 0-1.
Researchers observed a nonsignificant trend toward lower all-cause mortality in the mechanical thrombectomy patients, which was also linked with improved recanalization, compared with usual care alone (risk ratio, 1.57; 95% confidence interval, 1.11-2.23; P = .01).
Mechanical thrombectomy did show a nonsignificant increase in the risk of recurrent stroke at 90 days, but this was largely driven by one study, and when that was excluded, the risk was similar between mechanical thrombectomy and no mechanical thrombectomy (J Am Coll Cardiol. 2015;66:2498-505).
“Although mechanical thrombectomy is beneficial, this procedure requires specialized centers of excellence; therefore, the widespread application of this therapy for acute ischemic stroke patients will likely remain limited for the foreseeable future,” wrote Dr. Islam Y. Elgendy of the University of Florida, Gainesville, and coauthors.
One author declared advisory board membership and research funding from private industry, but there were no other conflicts of interest declared.
In recent trials, removable devices consisting of self-expanding, clot-retrieving stents achieved higher rates of recanalization than did earlier methods of thrombus extraction, representing the first effective new treatment for stroke in nearly 20 years.
With absolute benefits substantially greater than systemic intravenous thrombolysis alone, the combination of intravenous tissue plasminogen activator and endovascular therapy have improved outcomes for selected patients who receive endovascular treatment within 6 hours of symptom onset, and further efforts to shorten the interval between emergency department arrival and treatment hold the promise of even better outcomes.
Dr. Gregory W. Albers of the Stanford Stroke Center at Stanford (Calif.) University, and Dr. Jonathan L. Halperin of the Cardiovascular Institute at the Mount Sinai Medical Center, New York, made these comments in an accompanying editorial (J Am Coll Cardiol. 2015;66:2506-9). Dr. Halperin has served as a consultant to Boston Scientific, Medtronic, and Johnson & Johnson. Dr. Albers has an equity interest in iSchemaView and is a consultant for iSchemaView and Medtronic.
In recent trials, removable devices consisting of self-expanding, clot-retrieving stents achieved higher rates of recanalization than did earlier methods of thrombus extraction, representing the first effective new treatment for stroke in nearly 20 years.
With absolute benefits substantially greater than systemic intravenous thrombolysis alone, the combination of intravenous tissue plasminogen activator and endovascular therapy have improved outcomes for selected patients who receive endovascular treatment within 6 hours of symptom onset, and further efforts to shorten the interval between emergency department arrival and treatment hold the promise of even better outcomes.
Dr. Gregory W. Albers of the Stanford Stroke Center at Stanford (Calif.) University, and Dr. Jonathan L. Halperin of the Cardiovascular Institute at the Mount Sinai Medical Center, New York, made these comments in an accompanying editorial (J Am Coll Cardiol. 2015;66:2506-9). Dr. Halperin has served as a consultant to Boston Scientific, Medtronic, and Johnson & Johnson. Dr. Albers has an equity interest in iSchemaView and is a consultant for iSchemaView and Medtronic.
In recent trials, removable devices consisting of self-expanding, clot-retrieving stents achieved higher rates of recanalization than did earlier methods of thrombus extraction, representing the first effective new treatment for stroke in nearly 20 years.
With absolute benefits substantially greater than systemic intravenous thrombolysis alone, the combination of intravenous tissue plasminogen activator and endovascular therapy have improved outcomes for selected patients who receive endovascular treatment within 6 hours of symptom onset, and further efforts to shorten the interval between emergency department arrival and treatment hold the promise of even better outcomes.
Dr. Gregory W. Albers of the Stanford Stroke Center at Stanford (Calif.) University, and Dr. Jonathan L. Halperin of the Cardiovascular Institute at the Mount Sinai Medical Center, New York, made these comments in an accompanying editorial (J Am Coll Cardiol. 2015;66:2506-9). Dr. Halperin has served as a consultant to Boston Scientific, Medtronic, and Johnson & Johnson. Dr. Albers has an equity interest in iSchemaView and is a consultant for iSchemaView and Medtronic.
Mechanical removal of a thrombus in addition to usual care is associated with significantly better functional outcomes than usual care in patients who have experienced an acute ischemic stroke, according to a meta-analysis published online Nov. 30 in Journal of the American College of Cardiology.
The analysis of nine trials of usual care with or without mechanical thrombectomy in 2,410 patients showed that those undergoing mechanical thrombectomy had a 45% greater likelihood of achieving a good functional outcome and a 67% greater chance of excellent functional outcome, defined respectively as a modified Rankin scale score of 0-2 or 0-1.
Researchers observed a nonsignificant trend toward lower all-cause mortality in the mechanical thrombectomy patients, which was also linked with improved recanalization, compared with usual care alone (risk ratio, 1.57; 95% confidence interval, 1.11-2.23; P = .01).
Mechanical thrombectomy did show a nonsignificant increase in the risk of recurrent stroke at 90 days, but this was largely driven by one study, and when that was excluded, the risk was similar between mechanical thrombectomy and no mechanical thrombectomy (J Am Coll Cardiol. 2015;66:2498-505).
“Although mechanical thrombectomy is beneficial, this procedure requires specialized centers of excellence; therefore, the widespread application of this therapy for acute ischemic stroke patients will likely remain limited for the foreseeable future,” wrote Dr. Islam Y. Elgendy of the University of Florida, Gainesville, and coauthors.
One author declared advisory board membership and research funding from private industry, but there were no other conflicts of interest declared.
Mechanical removal of a thrombus in addition to usual care is associated with significantly better functional outcomes than usual care in patients who have experienced an acute ischemic stroke, according to a meta-analysis published online Nov. 30 in Journal of the American College of Cardiology.
The analysis of nine trials of usual care with or without mechanical thrombectomy in 2,410 patients showed that those undergoing mechanical thrombectomy had a 45% greater likelihood of achieving a good functional outcome and a 67% greater chance of excellent functional outcome, defined respectively as a modified Rankin scale score of 0-2 or 0-1.
Researchers observed a nonsignificant trend toward lower all-cause mortality in the mechanical thrombectomy patients, which was also linked with improved recanalization, compared with usual care alone (risk ratio, 1.57; 95% confidence interval, 1.11-2.23; P = .01).
Mechanical thrombectomy did show a nonsignificant increase in the risk of recurrent stroke at 90 days, but this was largely driven by one study, and when that was excluded, the risk was similar between mechanical thrombectomy and no mechanical thrombectomy (J Am Coll Cardiol. 2015;66:2498-505).
“Although mechanical thrombectomy is beneficial, this procedure requires specialized centers of excellence; therefore, the widespread application of this therapy for acute ischemic stroke patients will likely remain limited for the foreseeable future,” wrote Dr. Islam Y. Elgendy of the University of Florida, Gainesville, and coauthors.
One author declared advisory board membership and research funding from private industry, but there were no other conflicts of interest declared.
FROM JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Key clinical point: Mechanical thrombectomy and usual care are associated with significantly better functional outcomes after acute ischemic stroke than is usual care alone.
Major finding: Patients undergoing mechanical thrombectomy had a 67% greater likelihood of excellent functional outcome than patients having usual care alone.
Data source: Meta-analysis of nine trials of usual care with or without mechanical thrombectomy in 2,410 patients.
Disclosures: One author declared advisory board membership and research funding from private industry, but there were no other conflicts of interest declared.
