IMPORTANCE: Endovascular intervention for acute @entity385 improves revascularization. But trials examining endovascular therapy yielded variable functional outcomes, and the effect of endovascular intervention among subgroups needs better definition. OBJECTIVE: To examine the association between endovascular mechanical thrombectomy and clinical outcomes among @entity1 with acute @entity385 . DATA SOURCES: We systematically searched MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library without language restriction through August 2015. STUDY SELECTION: Eligible studies were randomized clinical trials of endovascular therapy with mechanical thrombectomy vs standard medical care, which includes the use of intravenous @entity1456 (tPA). DATA EXTRACTION AND SYNTHESIS: Independent reviewers evaluated the quality of studies and abstracted the data. We calculated odds ratios (ORs) and 95% CIs for all outcomes using random-effects meta-analyses and performed subgroup and sensitivity analyses to examine whether certain imaging, @entity1 , treatment, or study characteristics were associated with improved functional outcome. The strength of the evidence was examined for all outcomes using the GRADE method. MAIN OUTCOMES AND MEASURES: Ordinal improvement across modified Rankin scale (mRS) scores at 90 days, functional independence (mRS score, 0-2), angiographic revascularization at 24 hours, symptomatic @entity932 within 90 days, and all-cause mortality at 90 days. RESULTS: Data were included from 8 trials involving 2423 @entity1 (mean [SD] age, 67.4 [14.4] years; 1131 [46.7%] @entity1 ), including 1313 who underwent endovascular thrombectomy and 1110 who received standard medical care with tPA. In a meta-analysis of these trials, endovascular therapy was associated with a significant proportional treatment benefit across mRS scores (OR, 1.56; 95% CI, 1.14-2.13; P   =   .005). Functional independence at 90 days (mRS score, 0-2) occurred among 557 of 1293 @entity1 (44.6%; 95% CI, 36.6%-52.8%) in the endovascular therapy group vs 351 of 1094 @entity1 (31.8%; 95% CI, 24.6%-40.0%) in the standard medical care group (risk difference, 12%; 95% CI, 3.8%-20.3%; OR, 1.71; 95% CI, 1.18-2.49; P   =   .005). Compared with standard medical care, endovascular thrombectomy was associated with significantly higher rates of angiographic revascularization at 24 hours (75.8% vs 34.1%; OR, 6.49; 95% CI, 4.79-8.79; P   <   .001) but no significant difference in rates of symptomatic @entity932 within 90 days (70 events [5.7%] vs 53 events [5.1%]; OR, 1.12; 95% CI, 0.77-1.63; P   =   .56) or all-cause mortality at 90 days (218 deaths [15.8%] vs 201 deaths [17.8%]; OR, 0.87; 95% CI, 0.68-1.12; P   =   .27). CONCLUSIONS AND RELEVANCE: Among @entity1 with acute @entity385 , endovascular therapy with mechanical thrombectomy vs standard medical care with tPA was associated with improved functional outcomes and higher rates of angiographic revascularization, but no significant difference in symptomatic @entity932 or all-cause mortality at 90 days.

Endovascular Thrombectomy for Acute XXXX : A Meta-analysis.

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient'] @entity1456 :: ('100128998', 'Gene') :: ['tissue plasminogen activator'] @entity932 :: ('MESH:D020300', 'Disease') :: ['intracranial hemorrhage'] @entity385 :: ('MESH:D002544', 'Disease') :: ['ischemic stroke']
@entity385 :: (MESH:D002544,Disease) :: ['Ischemic Stroke']
