Outcomes of mechanical endovascular therapy for acute ischemic stroke: A clinical registry study and systematic review

Aymeric Rouchaud, Mikael Mazighi, Julien Labreuche, Elena Meseguer, Jean Michel Serfaty, Jean Pierre Laissy, Philippa C. Lavallée, Lucie Cabrejo, Céline Guidoux, Bertrand Lapergue, Isabelle F. Klein, Jean Marc Olivot, Halim Abboud, Olivier Simon, Elisabeth Schouman-Claeys, Pierre Amarenco

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE-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. METHODS-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. RESULTS-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). CONCLUSIONS-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.

Original languageEnglish (US)
Pages (from-to)1289-1294
Number of pages6
JournalStroke
Volume42
Issue number5
DOIs
StatePublished - May 2011
Externally publishedYes

Keywords

  • alteplase
  • endovascular therapy
  • mechanical approach
  • recombinant tissue plasminogen activator
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

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    Rouchaud, A., Mazighi, M., Labreuche, J., Meseguer, E., Serfaty, J. M., Laissy, J. P., Lavallée, P. C., Cabrejo, L., Guidoux, C., Lapergue, B., Klein, I. F., Olivot, J. M., Abboud, H., Simon, O., Schouman-Claeys, E., & Amarenco, P. (2011). Outcomes of mechanical endovascular therapy for acute ischemic stroke: A clinical registry study and systematic review. Stroke, 42(5), 1289-1294. https://doi.org/10.1161/STROKEAHA.110.599399