Endovascular thrombectomy for the treatment of acute ischemic stroke

ABSTRACT

Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments.

ObjectiveTo systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs).

Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015).

RESULTSFrom the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020.

ConclusionEvidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

RESUMO

Poucos pacientes se beneficiam do atual tratamento para o acidente vascular cerebral isquêmico agudo (AVCIA), incentivando o desenvolvimento de novos tratamentos.

ObjetivoRevisão sistemática da literatura sobre a eficácia e/ou segurança da trombectomia endovascular (TE) em AVCIA comparado com tratamento padrão (TP) e identificar ensaios clínicos randomizados controlados (ECR) atualmente em andamento.

MétodoBuscas por ECRs foram conduzidas no Medline, Embase, International Clinical Trial Registry Platform, Clinicaltrials.gov e no ISRCTN registry (to June 15th, 2015).

ResultadosOito ECRs publicados foram identificados, dos quais cinco mostraram superioridade do tratamento com trombectomia comparado ao TP. Dos 13 ERCs registrados, 3 foram suspensos, um não iniciou, um tem status desconhecido e oito encerrarão recrutamento entre 2016 e 2020.

ConclusãoA evidência favorece a combinação do TP com a TE em relação ao TP somente. Os critérios de inclusão limitam o número daqueles que poderiam se beneficiar. Mais estudos são necessários para demonstrar o custo-efetividade desta intervenção.

stroke - thrombectomy - systematic review - randomized controlled trial

acidente vascular cerebral - trombectomia - revisão sistemática - ensaios clínicos randomizados controlados

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