Abstract 18322: No Short-term Mortality Benefit With Endovascular Therapy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis
Background: The efficacy of endovascular treatment in improving functional outcome in acute ischemic stroke has been established. However, it is unclear if there is any beneficial effect on mortality in stroke patients undergoing prompt endovascular treatment.
Methods: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus were searched from inception through June 2015 for randomized controlled trials that compared endovascular treatment to the current standard of care in acute ischemic stroke. Studies were selected if they had short-term (90 day) mortality as a measured outcome. Mortality was pooled and odds ratio (OR) was calculated using the Mantel-Haenszel method using a fixed effect model.
Results: There were 10 studies with 2835 participants in our analysis. There were 224/1513 (14.8%) deaths reported in the endovascular treatment arm and 214/1322 (16.2%) deaths in the current standard of care arm. There was no difference in 90 day mortality between endovascular treatment and current standard of care (OR 0.86, 95% CI= 0.70-1.06, p =0.51; I2 = 0%). The Figure shows forest plot comparing 90-day mortality in the endovascular treatment arm and the current standard of care arm in patients with acute ischemic stroke. There was visual estimation of publication bias which was not confirmed by trim and fill method.
Conclusions: In this meta-analysis we did not find any short term mortality benefit with rapid endovascular treatment as compared to current standard of care. With the improvement demonstrated in functional outcomes, endovascular intervention represents a paradigm shift in stroke therapy. However, more studies are needed to look at both short and long-term survival and cost effectiveness of the modality.
Author Disclosures: S. Khan: None. H. Salahuddin: None. K.A. Cabatingan: None. F.K. Luni: None. A.R. Khan: None. M.A. Buehler: None. S.F. Zaidi: None. M.A. Jumaa: None. G.V. Moukarbel: None.
- © 2015 by American Heart Association, Inc.