Endovascular Treatment Versus Intravenous Thrombolysis for Acute Ischemic Stroke: a Quantitative Review and Meta-Analysis of 21 Randomized Trials.

Emerging studies suggest that endovascular treatment (EVT) may be superior to intravenous thrombolysis for acute ischemic stroke (AIS). We performed a systematic review and meta-analysis of all randomized controlled trials (RCTs) to assess the efficacy and safety of endovascular treatment in patients with acute ischemic stroke as compared with intravenous thrombolysis. We assessed RCTs investigating EVT versus intravenous thrombolysis (IVT) published up to June 2015. In total, 21 studies of 4473 patients were included in the systematic review and meta-analysis. EVT significantly improved functional outcome at 90 days (risk ratio (RR) 1.35, 95 % confidence interval (CI) 1.18 to 1.55, I 2  = 61 %) and reduced the mortality (RR 0.81, 95 % CI 0.68 to 0.95, I 2  = 0 %), with similar symptomatic hemorrhagic transformation (SHT) rate (RR 1.12, 95 % CI 0.88 to 1.44, I 2  = 0 %). Based on the current data, endovascular therapy may produce good clinical outcomes with similar symptomatic hemorrhage and mortality as compared with intravenous thrombolysis in acute ischemic stroke. This advancing intervention is a landmark change in stroke treatment and could be of huge potential benefit to patients worldwide.