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Endovascular thrombectomy for large ischemic strokes: An updated living systematic review and meta-analysis of randomized clinical trials.
Morsi, Rami Z; Elfil, Mohamed; Ghaith, Hazem S; Aladawi, Mohammad; Elmashad, Ahmed; Kothari, Sachin; Desai, Harsh; Ghozy, Sherief; Prabhakaran, Shyam; Amuluru, Krishna; Gandhi, Chirag D; Kass-Hout, Tareq; Al-Mufti, Fawaz.
Afiliação
  • Morsi RZ; Department of Neurology, University of Chicago, Chicago, IL, USA.
  • Elfil M; Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
  • Ghaith HS; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
  • Aladawi M; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
  • Elmashad A; Department of Neurology, University of Connecticut, Farmington, CT, USA.
  • Kothari S; Department of Neurology, University of Chicago, Chicago, IL, USA.
  • Desai H; Department of Neurology, University of Chicago, Chicago, IL, USA.
  • Ghozy S; Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
  • Prabhakaran S; Department of Neurology, University of Chicago, Chicago, IL, USA.
  • Amuluru K; Goodman Campbell Brain and Spine, Carmel, IN, USA; Neurointerventional Radiology, Ascension St. Vincent Hospital, Indianapolis, IN, USA.
  • Gandhi CD; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
  • Kass-Hout T; Department of Neurology, University of Chicago, Chicago, IL, USA. Electronic address: kasshouttareq@gmail.com.
  • Al-Mufti F; Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA. Electronic address: Fawaz.Al-Mufti@wmchealth.org.
J Neurol Sci ; 460: 123003, 2024 May 15.
Article em En | MEDLINE | ID: mdl-38640579
ABSTRACT

BACKGROUND:

Recent studies indicate endovascular thrombectomy (EVT) as a safe, effective treatment for acute ischemic stroke (AIS) with large ischemic regions. Our study updates an ongoing living systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of EVT to medical management only.

METHODS:

We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs comparing EVT to medical management in AIS patients with large ischemic areas. Using fixed-effect models, we conducted a meta-analysis to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management. We evaluated bias risk with the Cochrane tool and graded the certainty of evidence using the GRADE approach.

RESULTS:

Of 1363 new citations, we included six RCTs with a total of 1876 patients. We found low-certainty evidence of improved functional independence (risk difference [RD] 29.9%, 95% CI 17.2% to 46.9%), increase in sICH (RD 2.6%, 95% CI 0.3% to 6.4%), and a non-significant decrease in mortality (RD -1.8%, 95% CI -3.9% to 0.6%) for AIS patients with large infarcts who underwent EVT compared to medical management only.

CONCLUSION:

Our revised meta-analysis suggests low-certainty evidence that there is improved functional independence, a non-significant decrease in mortality, and an increase in sICH among AIS patients with large infarcts who undergo EVT compared to those receiving medical management alone. SYSTEMATIC REVIEW PROTOCOL REGISTRATION PROSPERO (CRD42023398742).
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ensaios Clínicos Controlados Aleatórios como Assunto / Trombectomia / Procedimentos Endovasculares / AVC Isquêmico Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ensaios Clínicos Controlados Aleatórios como Assunto / Trombectomia / Procedimentos Endovasculares / AVC Isquêmico Limite: Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article