Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Descripción del Articulo

uchinok@ccf.org
Detalles Bibliográficos
Autores: Osanai, Toshiya, Pasupuleti, Vinay, Deshpande, Abhishek, Thota, Priyaleela, Roman, Yuani, Hernández, Adrian V., Uchino, Ken
Formato: artículo
Fecha de Publicación:2015
Institución:Universidad Peruana de Ciencias Aplicadas
Repositorio:UPC-Institucional
Lenguaje:inglés
OAI Identifier:oai:repositorioacademico.upc.edu.pe:10757/552402
Enlace del recurso:http://hdl.handle.net/10757/552402
Nivel de acceso:acceso abierto
Materia:Meta-analysis
Heparin
Hemorraghe
Systemic review
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dc.title.es_PE.fl_str_mv Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
spellingShingle Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Osanai, Toshiya
Meta-analysis
Heparin
Hemorraghe
Systemic review
title_short Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_fullStr Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
title_sort Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
author Osanai, Toshiya
author_facet Osanai, Toshiya
Pasupuleti, Vinay
Deshpande, Abhishek
Thota, Priyaleela
Roman, Yuani
Hernández, Adrian V.
Uchino, Ken
author_role author
author2 Pasupuleti, Vinay
Deshpande, Abhishek
Thota, Priyaleela
Roman, Yuani
Hernández, Adrian V.
Uchino, Ken
author2_role author
author
author
author
author
author
dc.contributor.author.fl_str_mv Osanai, Toshiya
Pasupuleti, Vinay
Deshpande, Abhishek
Thota, Priyaleela
Roman, Yuani
Hernández, Adrian V.
Uchino, Ken
dc.subject.es_PE.fl_str_mv Meta-analysis
Heparin
Hemorraghe
Systemic review
topic Meta-analysis
Heparin
Hemorraghe
Systemic review
description uchinok@ccf.org
publishDate 2015
dc.date.accessioned.es_PE.fl_str_mv 2015-05-06T17:04:59Z
dc.date.available.es_PE.fl_str_mv 2015-05-06T17:04:59Z
dc.date.issued.fl_str_mv 2015-05-06
dc.type.es_PE.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.citation.es_PE.fl_str_mv Osanai T, Pasupuleti V, Deshpande A, Thota P, Roman Y, Hernandez AV, et al. (2015) Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 10(4): e0122806. doi:10.1371/journal.pone.0122806
dc.identifier.issn.es_PE.fl_str_mv 1932-6203
dc.identifier.doi.es_PE.fl_str_mv 10.1371/journal.pone.0122806
dc.identifier.uri.es_PE.fl_str_mv http://hdl.handle.net/10757/552402
dc.identifier.eissn.es_PE.fl_str_mv 1932-6203
dc.identifier.journal.es_PE.fl_str_mv PLoS ONE
identifier_str_mv Osanai T, Pasupuleti V, Deshpande A, Thota P, Roman Y, Hernandez AV, et al. (2015) Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 10(4): e0122806. doi:10.1371/journal.pone.0122806
1932-6203
10.1371/journal.pone.0122806
PLoS ONE
url http://hdl.handle.net/10757/552402
dc.language.iso.es_PE.fl_str_mv eng
language eng
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eu_rights_str_mv openAccess
dc.format.es_PE.fl_str_mv application/pdf
dc.publisher.es_PE.fl_str_mv The Public Library of Science (PLOS)
dc.source.es_PE.fl_str_mv Universidad Peruana de Ciencias Aplicadas (UPC)
Repositorio Académico - UPC
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collection UPC-Institucional
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spelling Osanai, ToshiyaPasupuleti, VinayDeshpande, AbhishekThota, PriyaleelaRoman, YuaniHernández, Adrian V.Uchino, Ken2015-05-06T17:04:59Z2015-05-06T17:04:59Z2015-05-06Osanai T, Pasupuleti V, Deshpande A, Thota P, Roman Y, Hernandez AV, et al. (2015) Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS ONE 10(4): e0122806. doi:10.1371/journal.pone.01228061932-620310.1371/journal.pone.0122806http://hdl.handle.net/10757/5524021932-6203PLoS ONEuchinok@ccf.orgBackground Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.Revisión por paresapplication/pdfengThe Public Library of Science (PLOS)http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122806info:eu-repo/semantics/openAccessUniversidad Peruana de Ciencias Aplicadas (UPC)Repositorio Académico - UPCreponame:UPC-Institucionalinstname:Universidad Peruana de Ciencias Aplicadasinstacron:UPCMeta-analysis4c001399-3024-4184-aa80-57a88f8d727d600Heparinea4b4902-27f4-46e7-9091-9bbd074330e0600Hemorraghef851c571-e065-4fd0-b562-59d0e90e15e9600Systemic revieweeef2a9c-a622-4c69-b09f-60647e11bf17600Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trialsinfo:eu-repo/semantics/article2018-06-15T22:05:17ZBackground Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. 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Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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