Stent Retrievers for Management of Acute Ischemic Stroke

Oct 27, 2015   |  Hitinder S. Gurm, MBBS, FACC
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Authors:
Marmagkiolis K, Hakeem A, Cilingiroglu M, et al.
Citation:
Safety and Efficacy of Stent Retriever for the Management of Acute Ischemic Stroke: Comprehensive Review and Meta-Analysis. JACC Cardiovasc Interv 2015;Oct 6:[Epub ahead of print].

The following are 10 points to remember about this review and meta-analysis on the safety and efficacy of stent retriever for the management of acute ischemic stroke:

  1. Stroke is the leading cause of disability and third leading cause of death in the United States.
  2. Early recanalization has been associated with better outcome in patients with ischemic stroke.
  3. Intravenous thrombolysis within 4.5 hours after the onset of acute stroke symptoms is the most widely accepted strategy for prompt recanalization.
  4. Stent retrievers are endovascular devices that provide vessel recanalization via thrombus retrieval. They are deployed inside the clot in order to envelop it within the stent struts, followed by retrieval of the device with the entrapped thrombus.
  5. The authors included five trials in a meta-analysis that evaluated stent retrievers for stroke. Of these, MR CLEAN (MR CLEAN: Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) included the largest number of patients (n = 500), followed by ESCAPE (n = 315).
  6. The overall frequency of functional independence (defined as a 90-day modified Rankin Score of 0-2) was greater in the intervention group compared with controls (42.6% vs. 26.1%; odds ratio [OR], 2.43; 95% confidence interval [CI], 1.91-3.09; p < 0.0001).
  7. There was no difference in intracranial bleeding between the two groups (4.2% vs. 4.3%; relative risk [RR], 1.08; 95% CI, 0.64-1.82; p = 0.78).
  8. There was no difference in 90-day mortality (15.1% in the intervention group compared with 18.7% in the control group; RR, 0.81; 95% CI, 0.58-1.12; p = 0.19).
  9. Ongoing trials are evaluating the utility of stent retrievers in patients presenting later or in those not treated with tissue plasminogen activator.
  10. Stent retrievers are associated with improved functional recovery with no increase in intracranial bleeding and possibly a reduction in mortality among patients presenting with large ischemic strokes.

Keywords: Intracranial Hemorrhages, Risk, Stents, Stroke, Thrombosis, Tissue Plasminogen Activator


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