Neurothrombectomy devices for the treatment of acute XXXX : state of the evidence.

@entity1 @entity64 @entity932 @entity63 @entity385
BACKGROUND: Acute @entity63 @entity64 are associated with poor outcomes and high health care burden. Evidence exists evaluating the use of neurothrombectomy devices in @entity1 receiving currently recommended treatments that may have limited efficacy. PURPOSE: To describe the state of the evidence supporting use of neurothrombectomy devices in the treatment of acute @entity385 . DATA SOURCES: MEDLINE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Web of Science were searched, without language restrictions, from their inception through May 2010. The MEDLINE and Cochrane Central Register of Controlled Trials searches were updated through November 2010. STUDY SELECTION: Two independent investigators screened citations for @entity1 studies of any design or case series or case reports of @entity1 with an acute @entity385 that evaluated a neurothrombectomy device and reported at least 1 clinical effectiveness outcome or harm. DATA EXTRACTION: Using standardized protocols, 2 independent investigators extracted information about study characteristics and outcomes, and a third reviewer resolved disagreement. DATA SYNTHESIS: 87 articles met eligibility criteria, including 18 prospective single-group studies, 7 noncomparative retrospective studies, and 62 case series or case reports. Two U.S. Food and Drug Administration (FDA)-cleared devices, the MERCI Retriever (Concentric Medical, Mountain View, California) (40%) and the Penumbra System (Penumbra, Alameda, California) (9%), represented a large portion of the available data. All prospective and retrospective studies provided data on successful recanalization with widely varying rates (43% to 78% with the MERCI Retriever and 83% to 100% with the Penumbra System). Rates of harms, including symptomatic (16 studies; 0% to 10% with the MERCI Retriever and 0% to 11% with the Penumbra System) or asymptomatic (13 studies; 28% to 43% and 1% to 30%, respectively) @entity932 and vessel perforation or dissection (11 studies; 0% to 7% and 0% to 5%, respectively), also varied by device. Predictors of harm included older age, history of @entity64 , and higher baseline @entity64 severity scores, whereas successful recanalization was the sole predictor of good outcomes. LIMITATIONS: Most available data are from single-group, noncomparative studies. In addition, the @entity1 population most likely to benefit from these devices is undetermined. CONCLUSION: Currently available neurothrombectomy devices offer intriguing treatment options in @entity1 with acute @entity385 . Future trials should use a randomized design, with adequate power to show equivalency or noninferiority between competing strategies or devices, and strive to identify populations that are most likely to benefit from use of neurothrombectomy devices. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
