Endovascular mechanical thrombectomy for anterior circulation stroke: a meta-analysis of randomized controlled trials

Abstract

Objective To evaluate the efficacy and safety of endovascular mechanical thrombectomy in patients with anterior circulation stroke. Methods PubMed, EMBASE, Cochrane database, Clinical Trials and the related supplement resources were retrieved. The randomized controlled trials for comparing intravenous thrombolysis and endovascular mechanical thrombectomy in patients with anterior circulation stroke were selected. The bias risk assessment was performed. The basic characteristics of studies and the clinical outcome data at day 90, including good outcome (defined as the modified Rankin scale score 0-2), death and symptomatic intracranial hemorrhage (sICH) were extracted. Review Manager 5.3 software was used to conduct the statistical analysis. Results A total of 10 articles were enrolled, including 1 557 patients in the endovascular mechanical thrombectomy group and 1 359 in the intravenous thrombolysis group. The overall quality of the included trials was higher. The risk of bias was lower. The good outcome rate in the endovascular mechanical thrombectomy group was significantly higher than that in the intravenous thrombolysis group (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.34-3.46; P<0.01). The death risk at day 90 was significantly lower than that in the intravenous thrombolysis group (OR 0.86, 95% CI 0.69-1.06; P=0.16), and there was borderline statistical significance for the risk of sICH (OR 1.35, 95% CI 1.00-1.84; P=0.05). Conclusions The effectiveness of the endovascular mechanical thrombectomy is superior to the intravenous thrombolysis in patients with anterior circulation stroke; however, in terms of safety, further evaluation is needed. Key words: Stroke; Brain Ischemia; Thrombolytic Therapy; Thrombectomy; Endovascular Procedures; Treatment Outcome; Meta-Analysis