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Ischemic Stroke
Original research
Mortality reduction after thrombectomy for acute intracranial large vessel occlusion: meta-analysis of randomized trials
  1. Kurt A Yaeger1,
  2. Michael L Martini1,
  3. Trevor Hardigan1,
  4. Travis Ladner1,
  5. Qing Hao2,
  6. I Paul Singh1,
  7. J Mocco1
  1. 1 Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2 Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Kurt A Yaeger, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; kurt.yaeger{at}mountsinai.org

Abstract

Background Thrombectomy for patients with emergent large vessel occlusion (ELVO) is currently recognized as the standard of care for appropriately selected patients. As proven in several randomized clinical trials and meta-analyses, treatment with thrombectomy lowers rates of poor functional outcomes after ELVO, compared with standard medical management. However, combined mortality rates of the most recent, high-quality clinical trials have not been collectively assessed.

Objective The goal of this study was to assess the combined mortality rates of patients with ELVO following thrombectomy using data from the most recent, high-quality clinical trials.

Methods Meta-analysis was performed in clinical trials comparing thrombectomy and medical management for patients with anterior circulation ELVO. Cumulative rates of mortality (mRS 6) as well as mortality or severe disability (mRS 5-6) were calculated.

Results Ten clinical trials fit the inclusion criteria, including PISTE, REVASCAT, DAWN, THRACE, SWIFT PRIME, ESCAPE, DEFUSE 3, THERAPY, EXTEND-IA, and MR CLEAN, with 2233 patients assessed for mortality alone and 2229 for mortality or severe disability. There was a significantly reduced risk of death with thrombectomy compared with standard medical care (14.9% vs 18.3%, P=0.03; RR 0.81, 95% CI 0.67 to 0.98), as well as a reduced risk of mortality or severe disability (mRS 5–6) in ELVO patients treated with thrombectomy (21.1% vs 30.5%, P<0.0001; RR 0.69, 95% CI 0.60 to 0.80).

Conclusions Overall, these results suggest a lower risk of death, as well as death or severe disability, in patients with ELVO treated with thrombectomy compared with medical management alone.

  • ischemic stroke
  • mechanical thrombectomy
  • mortality
  • severe disability
  • meta-analysis

http://dx.doi.org/10.1136/neurintsurg-2019-015383

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    Footnotes

    • Contributors All authors have made a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data; drafted the work or revised it for significant intellectual content; approved the final version of the manuscript; and agree to be accountable for all aspects of the work, including its accuracy and integrity.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests KY, MM, TH, TL, QH, and PS have no relevant conflicts of interest to report. JM receives research support from Stryker, Penumbra, Medtronic, and Microvention. JM is also a consultant for Imperative Care, Cerebrotech, Viseon, Endostream, Rebound Therapeutics, and Vastrax. No funds were received in support of this work.

    • Patient consent for publication Not required.

    • Ethics approval Approval was obtained from the Institutional Review Board of Mount Sinai.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.