Wild, C. and Emprechtinger, R. (2016): Endovascular therapy using mechanical thrombectomy devices for acute ischaemic stroke. National Report: German Summary of the correspondent EUnetHTA Report. Decision Support Document 94.
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Background: Intravenous treatment with t-PA is the established intervention for the treatment of ischaemic stroke. In recent years several methods for the mechanical removal of the causative thrombus (mechanical thrombectomy) have been developed. Due to lack of clinical evidence, the benefit of mechanical thrombectomy for the patients was so far unknown. This report is summarising the currently available evidence on efficacy and safety of thrombectomy plus standard therapy compared to standard therapy alone.
Method: A systematic search for randomised controlled trials was conducted to investigate the efficacy of mechanical thrombectomy. Other prospective study designs were also taken into account to describe the safety of the intervention. The reported effects of individual trials were combined in meta-analyses with regard to various endpoints.
Results: With regard to efficacy, the clinical evidence suggests that morbidity and functionality is improved with mechanical thrombectomy combined with standard treatment, compared to standard treatment alone. Patients in the intervention group had on average better results with respect to activities of daily living (ADL). No evidence was found however that that the intervention is associated with a lower overall mortality. With regard to safety an increased probability of cerebral haemorrhage was observed in the intervention groups. Symptomatic intracranial haemorrhages however showed no statistically significant differences.
Conclusion and Recommendation: The available evidence suggests that mechanical thrombectomy for the treatment of ischaemic stroke combined with the standard of care is -under certain conditions– superior to the standard treatment alone. It should be noted that the effect was only observed in a selected group of patients (e.g. exclusively in vascular occlusion in the anterior circulation) and under certain preconditions (e.g. with stent retrievers after previous vascular imaging).
|Item Type:||Decision Support Document|
|Keywords:||Stroke, neurology, thrombectomy, Stroke Unit|
|Subjects:||WB Practice of medicine > WB 300-962 Therapeutics|
WL Nervous system > WL 200-405 Central nervous system. Disorders. Therapeutics > WL 356 Brain ischemia. Stroke
WO Surgery > WO 500-517 Operative surgical procedures. Techniques
|Series Name:||Decision Support Document 94|
|Deposited on:||09 Mar 2016 13:38|
|Last Modified:||09 Mar 2016 16:49|
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