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10.1136/bmj.i1754 http://scihub22266oqcxt.onion/10.1136/bmj.i1754 C4834754!4834754 !27091337     free     free     free Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 213.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 247.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 247.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\27091337 .jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117       BMJ 2016 ; 353 (ä): i1754 Nephropedia Template TP {{tp|p=27091337 |t=2016. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis |pdf=|usr=}}{{27091337 }} gab.com Text Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis JO: BMJ http://www.kidney.de/pget.php?&tw=1&pmid=27091337 #FOAvip OBJECTIVES: To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ?2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. RESULTS: 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ?2) and excellent (scores ?1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95% confidence interval 1.38 to 1.75) for good functional outcomes and 0.86 (0.69 to 1.06) for mortality, without heterogeneity among the results of the studies. All trials were open label. Risk of bias was moderate across studies. The full results of two trials are yet to be published. CONCLUSIONS: Moderate to high quality evidence suggests that compared with medical care alone in a selected group of patients endovascular thrombectomy as add-on to intravenous thrombolysis performed within six to eight hours after large vessel ischaemic stroke in the anterior circulation provides beneficial functional outcomes, without increased detrimental effects. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019340. Twit Text FOAVip Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis ????BMJ http://www.kidney.de/pget.php?&tw=1&pmid=27091337 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=27091337 #FOAvip English Wikipedia <ref>{{Cite pmid|27091337 }}</ref> Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis #MMPMID27091337 Rodrigues FB ; Neves JB ; Caldeira D ; Ferro JM ; Ferreira JJ ; Costa J BMJ 2016[Apr]; 353 (ä): i1754 PMID27091337 show ga OBJECTIVES: To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ?2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. RESULTS: 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ?2) and excellent (scores ?1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95% confidence interval 1.38 to 1.75) for good functional outcomes and 0.86 (0.69 to 1.06) for mortality, without heterogeneity among the results of the studies. All trials were open label. Risk of bias was moderate across studies. The full results of two trials are yet to be published. CONCLUSIONS: Moderate to high quality evidence suggests that compared with medical care alone in a selected group of patients endovascular thrombectomy as add-on to intravenous thrombolysis performed within six to eight hours after large vessel ischaemic stroke in the anterior circulation provides beneficial functional outcomes, without increased detrimental effects. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019340. |Administration, Intravenous [MESH] |Brain Ischemia/complications/*therapy [MESH] |Embolectomy/*methods [MESH] |Endovascular Procedures/methods [MESH] |Fibrinolytic Agents/*therapeutic use [MESH] |Humans [MESH] |Intracranial Hemorrhages/epidemiology [MESH] |Mechanical Thrombolysis/*methods [MESH] |Stents [MESH] |Stroke/etiology/*therapy [MESH] |Thrombectomy/*methods [MESH] |Thrombolytic Therapy/*methods [MESH] |Tissue Plasminogen Activator/*therapeutic use [MESH]Endovascular treatment versus medical care alone for ischaemic stroke:(epmc).pdf DeepDyve Pubget Overpricing