A recent systematic review of mechanical thrombectomy trials shows that compared with patients that received thrombolysis alone, patients that received mechanical thrombectomy with thrombolysis were more likely to be functionally independent.
There have been several major trials that demonstrated efficacy with major functional benefits for patients who have received mechanical thrombectomy. Mechanical thrombectomy involves the use of catheters to directly deliver (during angiography) a clot-disrupting or retrieval device to a clot that is occluding a cerebral artery.
The authors of the review, published in the Canadian Journal of Neurological Sciences, include members of the Ontario Stroke Network’s (OSN) Endovascular Implementation Workgroup, co-chaired by Dr Grant Stotts and Dr Timo Krings.
“This review is very important for a number of reasons,” said review co- author and OSN Director of Best Practices, Linda Kelloway. “It further confirms the benefits of endovascular treatment for improving outcomes for stroke patients; it has informed OSN’s provincial planning for implementation of endovascular treatment, such as identifying criteria for endovascular treatment centres, and developing protocols and tools to identify potential patients for treatment, patient transfer processes and an evaluation plan.
“The review also informed the recently released Ontario Health Technology Advisory Committee Recommendation for Mechanical Thrombectomy,” she said.
Several recent trials of mechanical thrombectomy appear to indicate that this treatment may be superior to thrombolysis alone for selected patients. The review conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of new-generation mechanical thrombectomy devices with intravenous thrombolysis (if eligible), compared with intravenous thrombolysis (if eligible) alone in patients with acute ischemic stroke caused by a proximal intracranial occlusion.
The review found that compared with patients treated medically, patients who received mechanical thrombectomy were more likely to be functionally independent as measured by a modified Rankin score. Mortality and symptomatic intracerebral hemorrhage were not significantly different between the two groups.
“Our systematic review included the five recent major clinical trials of mechanical clot extraction (thrombectomy) for patients with acute ischemic stroke that together demonstrate a clear functional benefit for patients receiving mechanical thrombectomy (with or without tissue Plasminogen Activator, tPA, thrombolysis) over the routine standard of care (mainly tPA alone),” said review co-author and Associate Professor, University of Toronto, Director, TIA and Minor Stroke (TAMS) Unit and OSN Best Practice Champion, Dr. Leanne K. Casaubon. “These results strongly support mechanical thrombectomy for acute ischemic stroke and should encourage its implementation at stroke centres designated to provide this new standard of care for patients with large artery occlusions causing acute ischemic stroke.”
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Anna Lambrinos, Alexis K. Schaink, Irfan Dhalla, Timo Krings, Leanne K. Casaubon, Nancy Sikich, Cheemun Lum, Aditya Bharatha, Vitor Mendes Pereira, Grant Stotts, Gustavo Saposnik, Linda Kelloway, Xuanqian Xie, Michael D. Hill.
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Communications Manager, Ontario Stroke Network