INTRODUCTION: A recent randomized controlled trial (RCT), the Multicenter 
Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in 
the Netherlands (MR CLEAN), demonstrated better outcomes with endovascular 
treatment compared with medical therapy for acute ischemic stroke (AIS). 
However, previous trials have provided mixed results regarding the efficacy of 
endovascular treatment for AIS. A meta-analysis of all available trial data was 
performed to summarize the available evidence.
METHODS: A literature search was performed to identify all prospective RCTs 
comparing endovascular therapies with medical management for AIS. Two datasets 
were created: (1) all patients randomized after confirmation of large vessel 
occlusion (LVO) (consistent with the contemporary standard of practice at the 
majority of centers); and (2) all patients with outcome data who underwent 
randomization regardless of qualifying vascular imaging. The pre-specified 
primary outcome measure was modified Rankin Scale score of 0-2 at 90 days. A 
fixed-effect model was used to determine significance.
RESULTS: Five prospective RCTs comparing endovascular therapies with medical 
management were included in dataset 1 (1183 patients) and six were included in 
dataset 2 (1903 total patients). Endovascular therapies were associated with 
significantly improved outcomes compared with medical management (OR 1.67, 95% 
CI 1.29 to 1.16, p=0.0001) for patients with LVO (dataset 1). This benefit 
persisted when patients from all six RCTs were included, even in the absence of 
confirmation of LVO (OR 1.27, 95% CI 1.05 to 1.54, p=0.019; dataset 2).
CONCLUSIONS: A meta-analysis of prospective RCTs comparing endovascular 
therapies with medical management demonstrates superior outcomes in patients 
randomized to endovascular therapy.