Outcomes of Mechanical Endovascular Therapy for Acute Ischemic Stroke A Clinical Registry Study and Systematic Review

• Published in: Stroke (1970) Vol. 42; no. 5; pp. 1289 - 1294
• Main Authors: Rouchaud, Aymeric, Mazighi, Mikael, Labreuche, Julien, Meseguer, Elena, Serfaty, Jean-Michel, Laissy, Jean-Pierre, Lavallée, Philippa C., Cabrejo, Lucie, Guidoux, Céline, Lapergue, Bertrand, Klein, Isabelle F., Olivot, Jean-Marc, Abboud, Halim, Simon, Olivier, Schouman-Claeys, Elisabeth, Amarenco, Pierre
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2011
• Subjects: Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Endovascular Procedures - adverse effects; Humans; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - therapy; Medical sciences; Neurology; Pharmacology. Drug treatments; Prognosis; Prospective Studies; Registries; Retrospective Studies; Stroke - diagnosis; Stroke - therapy; Thrombolytic Therapy; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; recombinant tissue plasminogen activator; Cerebral infarction; Stroke; Nervous system diseases; Prognosis; Serine endopeptidases; Enzyme; thrombectomy; Cardiovascular disease; Endovascular route; t-Plasminogen activator; endovascular therapy; Cerebral disorder; Vascular disease; Peptidases; Alteplase; Treatment; Central nervous system disease; Brain ischemia; Hydrolases; mechanical approach; Fibrinolytic; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.110.599399

Recanalization is a powerful predictor of stroke outcome in patients with arterial occlusion. Intravenous recombinant tissue plasminogen activator is limited by its recanalization rate, which may be improved with mechanical endovascular therapy (MET). However, the benefit and safety of MET remain to be determined. The aim of this study was to give reliable estimates of efficacy and safety outcomes of MET. We analyzed data from our prospective clinical registry and conducted a systematic review of all previous studies using MET published between January 1966 and November 2009. From April 2007 to November 2009, 47 patients with acute stroke were treated with MET at Bichat Hospital. The literature search identified 31 previous studies involving a total of 1066 subjects. In the meta-analysis, including our registry data, the overall recanalization rate was 79% (95% CI, 73-84). Meta-analysis of clinical outcomes showed a pooled estimate of 40% (95% CI, 34-46; 27 studies) for favorable outcome, 28% (95% CI, 23-33; 28 studies) for mortality, and 8% (95% CI, 6-10; 27 studies) for symptomatic intracranial hemorrhage. The likelihood of a favorable outcome increased with the use of thrombolysis (OR, 1.99; 95% CI, 1.23-3.22) and with proportion of patients with isolated middle cerebral artery occlusion (OR per 10% increase, 1.14; 95% CI, 1.04-1.25). MET is associated with acceptable safety and efficacy in stroke patients, and it may be a therapeutic option in those presenting with isolated middle cerebral artery occlusion.