Rapid Systematic Review: Intra-Arterial Thrombectomy (“Clot Retrieval”) for Selected Patients with Acute Ischemic Stroke
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- 作者：William J. Meurer ; MD ; MS&lowast ; ; Bradley E. Barth ; MD&dagger ; ; Gary Gaddis ; MD&Dagger ; ; Gary M. Vilke ; MD§ ; ; Samuel H.F. Lam ; MD§ ; ;
- 关键词：acute ischemic stroke ; mechanical intra-arterial thrombectomy ; rapid review
- 刊名：The Journal of Emergency Medicine
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：52
- 期：2
- 页码：255-261
- 全文大小：137 K
- 卷排序：52
文摘
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have “large vessel” strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA). The current rapid systematic review provides practicing emergency physicians updated information regarding mechanical thrombectomy as a treatment option for carefully selected AIS patients.MethodsA PubMed literature search was conducted from January 1996 to June 2016 and limited to human clinical trials written in English with relevant keywords. High-quality randomized controlled studies identified then underwent a structured review.ResultsIn total, 179 papers fulfilling the search criteria were screened and 8 appropriate articles were rigorously reviewed in detail and recommendations given on the effectiveness and indication of mechanical intra-arterial thrombectomy for the treatment of AIS.ConclusionsMechanical intra-arterial thrombectomy reduces long-term disability in a properly selected subset of patients who have an AIS caused by large vessel occlusion. Many of these patients will have failed to improve after intravenous administration of t-PA, and mortality is not increased when combined with t-PA. Careful screening criteria should be in place to identify the limited subset of patients to whom this therapy is delivered to derive optimal treatment benefits.