[P4.241] Intravenous Thrombolysis Versus Endovascular Treatment for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials
Nidaullah Mian,1Farhan Siddiq,2Mushtaq Qureshi,3Malik Adil,4Asif Khan,1Muhammad Suri,1Adnan Qureshi2
1St Cloud, MN, USA, 2Minneapolis, MN, USA, 3Blaine, MN, USA, 4Minneapolis, MN
OBJECTIVE: To test the hypothesis that endovascular treatment resulted in incremental benefit (compared with intravenous thrombolysis) among patients with acute ischemic stroke.
BACKGROUND: There is recent controversy regarding comparative outcomes of intravenous thrombolysis versus endovascular treatment for acute ischemic stroke patients.
METHODS: A search was made for randomized clinical trials comparing intravenous thrombolysis and endovascular treatment in acute ischemic stroke patients. A literature search of MEDLINE, PubMed, and Cochrane databases was supplemented by a review of bibliographies of relevant articles and personal files. A meta-analysis was performed using a random effects model because significant heterogeneity was observed. Outcomes compared included any post-thrombolytic intracerebral hemorrhage (ICH) or symptomatic ICH within 24-36 hours, and 3 month rate of favorable outcome (defined by a modified Rankin scale of 0-2) and mortality.
RESULTS: We analyzed six randomized trials totaling 645 patients (351 randomized to intravenous thrombolysis and 294 randomized to endovascular treatment). The end point of any post-thrombolytic ICH (645 patients analyzed; Odds Ratio [OR], 1.2; 95% confidence interval [CI], 0.6-2.3; P = 0.5) and symptomatic ICH (618 patients analyzed: OR, 1.3; 95% CI, 0.6-2.4; P = 0.7) was not different among patients treated with intravenous thrombolysis compared with endovascular treatment. The 3 month rate of favorable mRS outcomes (638 patients analyzed: OR, 1.6; 95% CI, 0.7-3.5; P = 0.2) and mortality (555 patients analyzed: OR, 0.8; 95% CI, 0.3-1.9; P = 0.6) was not different among patients treated with intravenous thrombolysis compared with endovascular treatment. In a subset analysis of randomized trials that compared intravenous thrombolysis with endovascular treatment following intravenous thrombolysis, 3 month rate of favorable outcomes, mRS or National Institute of Health Stroke Scale (NIHSS) (645 patients analyzed: OR, 1.8; 95% CI, 0.8-3.8; P = 0.2) was not different between the two treatment groups.
CONCLUSION: We did not observe any incremental benefit of endovascular treatment compared with intravenous thrombolysis among acute ischemic stroke patients.
Category - Cerebrovascular Disease and Interventional Neurology: Acute Stroke Therapy and Endovascular Stroke Cerebrovascular Disease and Interventional Neurology: Treatments
Wednesday, April 30, 2014 7:30 AM
P4: Poster Session IV: Cerebrovascular Disease and Interventional Neurology: Endovascular Neurology (7:30 AM-11:00 AM)