Table 1. Summary of the characteristics of included studies.
| Ciccone 2010[21] | Ciccone 2013[4] | Broderick 2013[5] | Kidwell 2013[6] | Berkhemer 2015[8] | Campbell 2015[9] | Goyal 2015[10] | Saver 2015[11] | Jovin 2015[12] | |
|---|---|---|---|---|---|---|---|---|---|
| No.of centers (country) | 4(Italy) | 24(Italy) | 58(41US,7Canada,4Australia,6Europe) | 22(21US,1Canada) | 16(Netherlands) | 10(9Australia,1New Zealand) | 22(11Canada,6US,3South Korea,1Ireland, 1UK) | 39(24US,15Europe) | 4(Spain) |
| No.of participants | 54 | 362 | 656 | 118 | 500 | 70 | 315 | 196 | 206 |
| Intervention | IAT (25) | IAT (181) | EVT(434) | EVT ± IVT(64) | EVT ± IVT(233) | EVT + IVT (35) | EVT ± IVT(165) | EVT + IVT(98) | EVT ± IVT(103) |
| Control | IVT(29) | IVT(181) | IVT(222) | Standard medical care ± IVT(54) | Standard medical care ± IVT(267) | IVT(35) | Standard medical care ± IVT (150) | IVT(98) | Standard medical care ± IVT(103) |
| Time to treatment/h | |||||||||
| EVT | 6 | 6 | 5 | 8 | 6 | 6 | 12 | 6 | 8 |
| IVT | 3 | 4.5 | 3 | 4.5 | 4.5 | 4.5 | 4.5 | 4.5 | 4.5 |
| Median Age (SD) /yr | |||||||||
| Intervention | 60.6 (13.7) | 66 (11) | 69(23–89) † | 66.4(13.2) # | 65.8(54.7–76.0) | 68.2(12.3) | 71(61–81) | 65.0(12.5) | 65.7(11.3) |
| 65.8(16.9) * * | |||||||||
| Control | 64.0 (11.7) | 67(11) | 68(23–84) † | 61.6(12.0) # | 65.7(55.5–76.4) | 70.2(11.8) | 70(60–80) | 66.3(11.3) | 67.2(9.5) |
| 69.4(15.9) * * | |||||||||
| Median NIHSS score (IQR)* | |||||||||
| Intervention | 17(11–19) | 13(9–17) | 17(7–40) † | 16(12–18) # | 17(14–21) | 17(9–19) | 16(13–20) | 17(13–20) | 17(14–20) |
| 19(17–22) * * | |||||||||
| Control | 16(12–19) | 13(9–18) | 16(8–30) † | 16(11–18) # | 18(14–22) | 13(13–20) | 17(12–20) | 17(13–19) | 17(12–19) |
| 20.5 (17–23) * * | |||||||||
| Median ASPECTS (IQR) ‡ | |||||||||
| Intervention | NA | NA | NA | NA | 9(7–10) | NA | 9(8–10) | 9(7–10) | 7(6–9) |
| Control | NA | NA | NA | NA | 9(8–10) | NA | 9(8–10) | 9(8–10) | 8(6–9) |
| Pretreatment vessel imaging | Not used | Not used | CTA/MRA | CTA/MRA | CTA/MRA | CTA/MRA | CTA | CTA/MRA | CTA/MRA |
| Occlusion sites | Anterior circulation(47) | Anterior circulation(330) | ICA(65) | ICA(20) | ICA(4) | ICA(22) | ICA+M1(84) | ICA(32) | ICA(1) |
| Posterior circulation(5) | Posterior circulation(29) | M1(135) | M1(78) | ICA+M1(134) | M1(38) | M1/all M2(216) | M1(134) | ICA+M1(53) | |
| M2(83) | M2(20) | M1(319) | M2(10) | Single M2(9) | M2(19) | M1(131) | |||
| BA(4) | M2(39) | M2(18) | |||||||
| Control NA | A1/A2(3) | ||||||||
| Types of EVT | IAT alone(10) | IAT alone(109) | MT alone(68) | MT alone (53) | MT alone(171) | MT alone(28) | MT alone(151) | MT alone (98) | MT alone(98) |
| IAT+ MT(9) | IAT+MT(56) | MT+IAT(266) | MT+IAT(8) | MT±IAT(24) | |||||
| IAT alone(1) | |||||||||
| Maximum dosage of IA rt-PA | 0.9mg/kg | 0.9mg/kg | 22mg | 14mg | 90mg,30mg if IVT was used | NA | NA | NA | NA |
| Mechanical devices | NA | Merci(5) | Merci(95) | Merci(37), | NA | Solitaire™FR (28) | Solitaire™FR(100) | Solitaire™ FR or Solitaire™ 2 (87) | Solitaire™ FR(98) |
| Penumbra(9) | Penumbra(54) | Penumbra(14) | |||||||
| Solitaire™FR(18) | Solitaire™ FR(5) | Both(10) | |||||||
| Trevo(5) | |||||||||
| Stent retrievers % | NA | 12.70% | 1.20% | 0% | 81.50% | 80.00% | 78.80% | 88.80% | 95.10% |
| IV rt-PA % | |||||||||
| Intervention | NA | NA | 100% | 43.80% | 87.10% | 100% | 72.70% | 100% | 67.90% |
| Control | 96.60% | 98.30% | 100% | 29.60% | 90.60% | 100% | 78.70% | 100% | 77.70% |
| General anesthesia in EVT (%) | NA | 22(12.2%) | 143(32.9%) | NA | 88(37.8%) | 12(34.3%) | 15(9.1%) | 36(36.7%) | 7(6.8%) |
| Onset to imaging/min | |||||||||
| Intervention | NA | NA | NA | NA | NA | NA | 134 | NA | 192 |
| Control | NA | NA | NA | NA | NA | NA | 136 | NA | 183 |
| Onset to IVT/min | |||||||||
| Intervention | NA | NA | 122.4 | NA | 85 | 127 | 110 | 110.5 | 117.5 |
| Control | 155 | 165 | 121.2 | NA | 87 | 145 | 125 | 117 | 105 |
| Onset to randomization/min | |||||||||
| Intervention | 125 | 148 | NA | NA | 204 | NA | 169 | 190.5 | 223 |
| Control | 125 | 145 | NA | NA | 196 | NA | 172 | 188 | 226 |
| Onset to groin puncture | NA | NA | NA | NA | 332[23] | 248 | 241 | 252|| | 355 |
| Onset to reperfusion in EVT | NA | NA | NA | NA | 332[23] | 248 | 241 | 252|| | 355 |
| Reperfusion%(TICI 2b-3) § | NA | NA | 41% | 27% | 58.70% | 86% | 72.40% | 88% | 67% |
BA = basilar artery, CTA = Computed tomography angiography; EVT = endovascular treatment; IAT = intra-arterial thrombolysis with rt-PA; ICA = intracranial carotid artery; IQR = interquartile range; IVT = intravenous thrombolysis with rt-PA; M1 = the first segment of middle cerebral artery; M2 = the second segments of middle cerebral artery; MRA = MR angiography; MT = mechanical thrombectomy; NA = not available; No = number; SD = standard deviation; TICI = thrombolysis in cerebral infarction.
* NIHSS: the National Institutes of Health Stroke Scale, a quantitative measure of neurological dysfunction after stroke ranging from 0 to 42, with a higher score indicating more severe neurological deficit;
† Mean (range);
‡ ASPECTS: the Alberta Stroke Program Early CT score; a 10-point scoring system to quantify early ischemic changes in the middle cerebral artery territory, with a score of 10 indicating normal and 1 point subtracted for each abnormal region;
§ TICI: a scoring system used to measure reperfusion of distal branches of occluded artery after mechanical thrombectomy, with 0 indicating no reperfusion, 1 little or slow distal reperfusion, 2a partial reperfusion of less than half of the distal branches, 2b partial reperfusion of more than half of the distal branches and 3 complete reperfusion. A TICI 2b to 3 is considered as substantial reperfusion;
|| Time to the first deployment of stent retrievers;
# Penumbral subgroup;
* * Nonpenumbral subgroup.