CardioBrief: Beware the Stroke Clot Extraction Hype

We should beware of this because this does not solve anything to do with the neuronal cascade of death.
http://www.medpagetoday.com/Cardiology/CardioBrief/54496?xid=nl_mpt_DHE_2015-11-06&eun=g424561d0r
Clot extraction (thrombectomy) for stroke has been on a roll lately.
After the failure of a series of trials a few years ago, investigators and industry went back to the drawing board. The result of their efforts -- a new and improved thrombectomy -- has brought about a dramatic reversal of fortune for the technology. In the past year, five newer trials have been stopped due to highly positive findings.

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Now a new meta-analysis published in the Journal of the American Medical Association confirms some of the good news, but it also offers reasons for caution.
Rory Spiegel, MD, an emergency medicine resident who writes the EM Nerd blog, has been writing about the recent trials with terrific depth and insight fueled by a healthy dose of skepticism. His meticulous and thoughtful analysis of the new meta-analysis is worth reading in full, but here are a few of the key points.
Spiegel doesn't argue that the recent thrombectomy trials are not valid or important. But he does argue powerfully that the broad application of the technology in clinical practice is not warranted by the data, which has significant limitations. In particular, Spiegel argues that there is no reason to believe that the current evidence supports a major national effort to bring thrombectomy to a large proportion of the population.
Spiegel says that the evidence is far too weak to provide a reliable estimate of the real effects of thrombectomy, so "it is difficult to assess whether this benefit justifies the resources required to support its implementation on a national level." Despite an impressive improvement in functional outcome at 90 days in the meta-analysis, Spiegel points to important limitations of this data:

• Higher revascularization rate with thrombectomy
• No difference in 90 day mortality of symptomatic intracranial hemorrhage
• No difference according to time-to-treatment, "once again calling into question the time is brain mantra so frequently proclaimed"
• A likely exaggerated effect due to stopping the trials early

Most importantly, Spiegel points to substantial heterogeneity in the trials, severely limiting the value of a meta-analysis. "What we have is a heterogeneous data set, ultimately providing more questions than answers," he concludes.
See Rory Spiegel's complete analysis here.