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Supplemental Digital Content is available in the text, The positive results of recent trials for the treatment of acute ischemic stroke have highlighted the importance of imaging selection before endovascular therapy. We performed a stratified meta-analysis to confirm this new understanding. We searched EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov in April 2015 for randomized controlled trials evaluating the effect of endovascular treatment in patients with acute ischemic stroke. The meta-analysis was stratified by whether computed tomographic angiography (CTA) was used to select patients. Outcome data were pooled using fixed-effects models. Seven randomized controlled trials with 2217 patients were included in this study. Endovascular therapy significantly increased the rate of 90-day functional independence (a modified Rankin score of 0–2) in patients with a CTA-confirmed large-vessel occlusion (relative risk [RR] = 1.75, 95% confidence interval [CI]: 1.48–2.06, I2 = 0.0%), and reduced 90-day mortality in patients with occlusion stroke with a small ischemic core (RR = 0.58, 95% CI: 0.37–0.89, I2 = 0.0%). The functional benefit was significantly greater in patients with CTA-based selection than in those without (Z = 5.04, P

Supplemental Digital Content is available in the text, Obstructive sleep apnea (OSA) is seen in approximately 60% to 70% of patients with stroke or ischemic heart disease (IHD). The relationship between OSA and recurrent vascular events and all-cause mortality remains inconclusive. We aimed to systematically evaluate the associations between OSA and serious adverse outcomes following stroke or IHD by a meta-analysis of prospective cohort studies. We searched MEDLINE and EMBASE in August 2014 for studies that evaluated the prospective associations between OSA and the risk of stroke, IHD, and death among stroke or IHD patients. Outcome data were pooled using random effects meta-analysis. Subgroup, heterogeneity, and sensitivity analyses and publication bias were performed. Of 13 hospital-based cohort studies included, 5 reported results on stroke (n = 860), 6 reported on IHD (n = 1083), and 11 reported on all-cause death or cardiovascular death (n = 1930). OSA was significantly associated with the risk of stroke, IHD, and all-cause mortality after stroke or IHD. The pooled relative risks were 1.94 (95% confidence interval [CI], 1.29–2.92) for stroke, 1.83 (95% CI, 1.15–2.93) for IHD, and 1.59 (95% CI, 1.33–1.89) for all-cause mortality. There was no evidence of significant between-study heterogeneity. The results did not materially change in the sensitivity analyses for the outcomes of stroke and all-cause mortality. OSA may be a significant predictor of serious adverse outcomes following stroke or IHD. More high-quality studies are needed to determine if better treatment of OSA leads to fewer recurrent vascular events, especially a large-scale, multicenter randomized-controlled trial.