Modern device thrombectomy improves 90-day outcomes after anterior circulation stroke
Mechanical thrombectomy with retrievable stents and aspiration catheters drastically reduces the risk of death or disability after 90 days in patients with acute anterior circulation ischemic stroke, according to a new meta-analysis published in EuroIntervention.
Data was extrapolated from 12 randomized controlled trials that assigned patients to thrombectomy or a control for the treatment of acute anterior circulation stroke. All patients were treated from January 2010 to July 2020.
Researchers analyzed data from a total of 1,276 patients treated with thrombectomy and 1,282 patients treated with a control. Using the modified Rankin scale (mRS), they found that thrombectomy "significantly reduced" disability after 90 days and reduced the risk of functional dependence after 90 days.
In addition, all-cause mortality after 90 days occurred in 16.1% of patients in the thrombectomy group and 19.2% of patients in the control group. The number needed to treat to prevent one death at 90 days was determined to be 32.
Also, symptomatic intracranial hemorrhage occurred at a similar rate for patients in the thrombectomy group (4.2%) and control group (4.0%).
“This is the first complete meta-analysis to demonstrate a significant reduction in all-cause mortality following mechanical thrombectomy,” wrote lead author Christopher A. Rajkumar, MD, with the National Heart and Lung Institute at Imperial College London, and colleagues.
Rajkumar et al. also noted that patient access to mechanical thrombectomy needs to be improved.
“The next step for the healthcare system is rapid expansion of the pool of specialists able to perform the technique and an increase in the provision of 24/7 CT vascular imaging and interpretation, and advanced stroke care," they wrote. "For the provision of imaging, cost efficiency may be improved through artificial intelligence to screen large numbers of images for eligibility.”
Read the full study here.