Background Early recanalization is strongly associated with improved functional outcomes and reduced mortality in acute ischemic stroke (AIS). This is the rationale that stands behind the use of intravenous (IV) or intra-arterial (IA) thrombolytics and the growing list of mechanical thrombectomy devices. There has been multiple small sized studies that have reported this positive association, however, we are lacking a recent review compilation demonstrating this.
Methods Data were collected through Medline search. We analyzed all articles published between the years 2002 and 2011 comparing various clinical outcomes including modified Rankin Scale (mRS) at 90 days, symptomatic intracranial hemorrhage, and mortality rate between non-revascularized and revascularized groups in the setting of AIS therapy. Search key words included recanalization, reperfusion, thrombolysis, thrombectomy, modified rankin scale, in combination with ischemic stroke and cerebral ischemia.
Results 73 studies reporting recanalization rate on 4390 patients were analyzed. Recanalization rate through various intervention approaches were extracted (IV thrombolytic 32%, IA 58%, mechanical thrombectomy 89%, and combined thrombolytic/mechanical 91%). Correlation between clinical outcomes and different revascularization therapies, location of the occlusion and the time from symptom onset to revascularization was only stratified in 68 studies. Patients with successful revascularization defined as Thrombolysis In Myocardial Infarction of 2–3 had a better functional clinical outcome compared to non-revascularized group (Pooled OR 6.01; 95% CI 4.87 to 7.18). Mortality rate was reduced in patients that were revascularized (Pooled OR 0.32; 95% CI 0.18 to 0.41). Symptomatic intracranial hemorrhage rate were reduced for the non-revascularized group, however it was not significant (p=0.31).
Conclusion This meta-analysis further supports the positive correlation between revascularization rate and good functional outcome and reduced mortality rate in AIS.
Competing interests E Nourollahzadeh: None. O Kass-Hout: None. M Mokin: None. R Aliotta: None. K Synder: Toshiba and ev3. A Siddiqui: NINDS 1R01NS064592-01A1, University at Buffalo. Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Codman & Shurtleff, Inc., Genentech. Hotspur, Intratech Medical, StimSox, Valor Medical. Abbott Vascular, an Emergency Medicine Conference, Neocure Group LLC, Genentech, American Association of Neurological Surgeons. E Levy: Codman & Shurtleff, Inc, ev3/Covidien Vascular Therapies, Boston Scientific, TheraSyn Sensors, Inc., Medical Ltd., Mynx/Access Closure. Boston Scientific. T Kass-Hout: Genentech.
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