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November 3, 2015

Thrombectomy for Acute Ischemic Stroke

Author Affiliations
  • 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
JAMA. 2015;314(17):1803-1805. doi:10.1001/jama.2015.14674

In this issue of JAMA, Badhiwala and colleagues1 report findings from a well-conducted systematic review and meta-analysis of randomized clinical trials (RCTs) of endovascular thrombectomy vs standard medical care for patients with acute ischemic stroke. The analysis included 8 trials invovled 2423 patients (1313 who underwent thrombectomy and 1110 who received standard medical care, including recombinant tissue plasminogen activator [rtPA] when indicated), published since 2013. The analysis showed that thrombectomy was associated with increased odds of a more favorable functional outcome (odds ratio [OR], 1.56; 95% CI, 1.14-2.13; P = .005), and increased functional independence (modified Rankin SCALE, 0-2) by 3 months (44.6% vs 31.8%; OR, 1.71; 95% CI, 1.18-2.49; P = .005), with no difference in symptomatic intracranial hemorrhage (5.7% vs 5.1%; OR, 1.12; 95% CI, 0.77-1.63; P = .56) or all-cause mortality at 90 days (15.8% vs 17.8%) OR, 0.87; 95% CI, 0.68-1.12; P = .27) compared with standard medical care.