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Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1754 (Published 18 April 2016) Cite this as: BMJ 2016;353:i1754

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Thrombectomy in comparison with medical therapy in patients with acute ischemic stroke: too many meta-analyses?

In the field of meta-analysis, one question that has been lively debated is whether confirmatory meta-analyses are useful or represent a waste of time and resources [1]. In evaluating the effectiveness of thrombectomy in comparison with medical therapy in acute ischemic stroke, there is agreement that only the randomized trials conducted in the last three years should be included in a meta-analysis [2]. Even if one adopts this restrictive selection criterion, the number of meta-analyses available from the current literature appear to be very numerous. Rodrigues et al [2] report that 3 “recent” meta-analyses were already available. Chiumente et al [3] had pointed out that there were 3 “recent” meta-analyses (4 including the one conducted by Chiumente et al). If one considers the overall information reported by Rodrigues et al and by Chiumente et al, a total of 6 “recent” meta-analyses on this topic prove to be available from the literature; overall, all of these studies were confirmatory of the results previously published by Badhiwala et al in 2015 [4]. So, the work by Rodrigues et al is the seventh contribution in this field. Did we need the seventh meta-analysis on this topic?

References

1. Goggins A. Duplicate systematic reviews. Repeated meta-analyses are both worthy and to be encouraged. BMJ. 2013 Sep 10;347:f5508.

2. Rodrigues FB, Neves JB, Caldeira D, Ferro JM, Ferreira JJ, Costa J. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis. BMJ. 2016 Apr 18;353:i1754.

3. Chiumente M, Trippoli S, Messori A. Differences in Effectiveness among Devices for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke. J Stroke. 2016 Feb 26. doi: 10.5853/jos.2015.01662.

4. Badhiwala JH, Nassiri F, Alhazzani W, et al Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis. JAMA 2015;314:1832-43.

Competing interests: No competing interests

21 April 2016
Andrea Messori
HTA Unit
Marco Chiumente, PharmD, SIFACT, Italian Society of Clinical Pharmacy and Therapeutics, 20100 Milano, Italy
ESTAR, Regional Health Service,
via San Salvi 10, 50100 Firenze, Italy