Endovascular thrombectomy for the treatment of acute ischemic stroke

Arq Neuropsiquiatr. 2016 Jan;74(1):67-74. doi: 10.1590/0004-282X20150182. Epub 2015 Nov 24.

Abstract

Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments.

Objective: To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs).

Method: Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015).

Results: From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020.

Conclusion: Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain / blood supply
  • Brain Ischemia / drug therapy
  • Brain Ischemia / surgery*
  • Endovascular Procedures / methods*
  • Evidence-Based Practice / statistics & numerical data
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Randomized Controlled Trials as Topic
  • Stroke / drug therapy
  • Stroke / surgery*
  • Thrombectomy / methods*
  • Tissue Plasminogen Activator / therapeutic use

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator