An international study and meta-analysis have found that mechanical thrombectomy and best medical management produce similar results in stroke patients with emergency large-vessel occlusion and mild resulting deficits.
Up to 10% of patients with emergency large-vessel occlusion treated within six hours can have mild deficits and deteriorate rapidly or gradually, leaving physicians in a conundrum of whether to treat them medically or mechanically, the researchers wrote. Previous studies offered conflicting results.
Researchers analyzed data from four studies of 251 patients treated within 24 hours of suffering a stroke. Treatment occurred at 16 high-volume endovascular stroke centers in North America, Europe and Asia between 2013 and 2017. Results showed higher odds of asymptomatic intracerebral hemorrhage among mechanical thrombectomy patients, and that mechanically treated patients also had lower rates of functional independence.
The researchers concluded that both treatments have similar efficacy and safety profiles. The study was published last week in JAMA Neurology. Its results were similar to those of a study published last year in the American Heart Association journal Stroke, but differed from those of a smaller meta-analysis published in 2018 in Plos One. That study found showed that patients who underwent mechanical thrombectomy had a significantly better 90-day stroke-related disability score but a higher rate of symptomatic intracranial hemorrhage compared with patients who had best medical management.