Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis
Background Patients with acute stroke presenting with large vessel occlusion secondary to intracranial atherosclerosis (ICAS‐LVO) may require rescue therapy (RT) in addition to mechanical thrombectomy to achieve and maintain successful recanalization. We performed a systematic review and meta‐analys...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-01-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000510 |
| _version_ | 1797258518269526016 |
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| author | Eyad Almallouhi Mohammad Hassan Murad Reda Chalhoub Kimberly P. Kicielinski Jonathan Lena Emily A. Brennan Osama Zaidat Adam de Havenon Alejandro M. Spiotta Sami Al Kasab |
| author_facet | Eyad Almallouhi Mohammad Hassan Murad Reda Chalhoub Kimberly P. Kicielinski Jonathan Lena Emily A. Brennan Osama Zaidat Adam de Havenon Alejandro M. Spiotta Sami Al Kasab |
| author_sort | Eyad Almallouhi |
| collection | DOAJ |
| description | Background Patients with acute stroke presenting with large vessel occlusion secondary to intracranial atherosclerosis (ICAS‐LVO) may require rescue therapy (RT) in addition to mechanical thrombectomy to achieve and maintain successful recanalization. We performed a systematic review and meta‐analysis of comparative studies that reported outcomes of RT in patients with ICAS‐LVO to evaluate its safety and efficacy. Methods Databases searched include PubMed, CINAHL Complete, and Scopus from database date of inception through August 17, 2021. We included comparative studies that reported the outcomes of ICAS‐LVO RT compared with outcomes of patients with ICAS‐LVO who did not undergo RT or to those patients presenting with embolic large vessel occlusion (non–ICAS‐LVO). Meta‐analysis using the random‐effects model was used to combine estimates reporting odds ratios (ORs) and 95% CIs. Results A total of 9 nonrandomized studies were included: 5 studies in ICAS‐LVO RT versus ICAS‐LVO non‐RT analysis and 5 in ICAS‐LVO RT versus non‐ICAS LVO analysis. Rescue treatments included intra‐arterial antiplatelets, angioplasty, stenting, or a combination of treatments. Compared with non‐RT ICAS‐LVO, RT was associated with an increased favorable 90‐day outcome (OR, 3.19 [95% CI, 1.91–5.32]; I2 = 14%) and decreased 90‐day mortality (OR, 0.35 [95% CI, 0.16–0.76]; I2 = 21%). In the analysis of ICAS‐LVO RT versus embolic LV, the incidence of favorable 90‐day outcome and 90‐day mortality did not differ between ICAS‐LVO RT and non–ICAS‐LVO (OR, 0.97 [95% CI, 0.58–1.64; I2 = 50%]; and OR, 1.22 [95% CI, 0.90–1.66; I2 = 0%], respectively). Conclusions Rescue treatment is likely associated with better outcomes in patients with ICAS‐LVO. The outcomes of patients with ICAS‐LVO who receive RT may be comparable with patients with embolic large vessel occlusion (non–ICAS‐LVO). |
| first_indexed | 2024-03-08T18:28:42Z |
| format | Article |
| id | doaj.art-5ef194185959499eadeee4c1908c7c9a |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-24T22:54:48Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-5ef194185959499eadeee4c1908c7c9a2024-03-18T06:39:33ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-01-013110.1161/SVIN.122.000510Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐AnalysisEyad Almallouhi0Mohammad Hassan Murad1Reda Chalhoub2Kimberly P. Kicielinski3Jonathan Lena4Emily A. Brennan5Osama Zaidat6Adam de Havenon7Alejandro M. Spiotta8Sami Al Kasab9Department of Neurosurgery Medical University of South Carolina Charleston SCKern Center for the Science of Healthcare Delivery Mayo Clinic Hospital Rochester MNDepartment of Neurosurgery Medical University of South Carolina Charleston SCDepartment of Neurosurgery Medical University of South Carolina Charleston SCDepartment of Neurosurgery Medical University of South Carolina Charleston SCDepartment of Research and Education Services (Libraries) Medical University of South Carolina Charleston SCDepartment of Endovascular Neurology and Neuroscience Mercy Health St. Vincent Medical Center Toledo OHDepartment of Neurology Yale University New Haven CTDepartment of Neurosurgery Medical University of South Carolina Charleston SCDepartment of Neurosurgery Medical University of South Carolina Charleston SCBackground Patients with acute stroke presenting with large vessel occlusion secondary to intracranial atherosclerosis (ICAS‐LVO) may require rescue therapy (RT) in addition to mechanical thrombectomy to achieve and maintain successful recanalization. We performed a systematic review and meta‐analysis of comparative studies that reported outcomes of RT in patients with ICAS‐LVO to evaluate its safety and efficacy. Methods Databases searched include PubMed, CINAHL Complete, and Scopus from database date of inception through August 17, 2021. We included comparative studies that reported the outcomes of ICAS‐LVO RT compared with outcomes of patients with ICAS‐LVO who did not undergo RT or to those patients presenting with embolic large vessel occlusion (non–ICAS‐LVO). Meta‐analysis using the random‐effects model was used to combine estimates reporting odds ratios (ORs) and 95% CIs. Results A total of 9 nonrandomized studies were included: 5 studies in ICAS‐LVO RT versus ICAS‐LVO non‐RT analysis and 5 in ICAS‐LVO RT versus non‐ICAS LVO analysis. Rescue treatments included intra‐arterial antiplatelets, angioplasty, stenting, or a combination of treatments. Compared with non‐RT ICAS‐LVO, RT was associated with an increased favorable 90‐day outcome (OR, 3.19 [95% CI, 1.91–5.32]; I2 = 14%) and decreased 90‐day mortality (OR, 0.35 [95% CI, 0.16–0.76]; I2 = 21%). In the analysis of ICAS‐LVO RT versus embolic LV, the incidence of favorable 90‐day outcome and 90‐day mortality did not differ between ICAS‐LVO RT and non–ICAS‐LVO (OR, 0.97 [95% CI, 0.58–1.64; I2 = 50%]; and OR, 1.22 [95% CI, 0.90–1.66; I2 = 0%], respectively). Conclusions Rescue treatment is likely associated with better outcomes in patients with ICAS‐LVO. The outcomes of patients with ICAS‐LVO who receive RT may be comparable with patients with embolic large vessel occlusion (non–ICAS‐LVO).https://www.ahajournals.org/doi/10.1161/SVIN.122.000510angioplastyICADintracranial atheroscelrosismechanical thrombectomyrescue therapystenting |
| spellingShingle | Eyad Almallouhi Mohammad Hassan Murad Reda Chalhoub Kimberly P. Kicielinski Jonathan Lena Emily A. Brennan Osama Zaidat Adam de Havenon Alejandro M. Spiotta Sami Al Kasab Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis Stroke: Vascular and Interventional Neurology angioplasty ICAD intracranial atheroscelrosis mechanical thrombectomy rescue therapy stenting |
| title | Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis |
| title_full | Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis |
| title_fullStr | Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis |
| title_full_unstemmed | Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis |
| title_short | Rescue Endovascular Treatment of Patients With Emergent Large Vessel Occlusion Attributed to Intracranial Atherosclerosis: A Systematic Review and Meta‐Analysis |
| title_sort | rescue endovascular treatment of patients with emergent large vessel occlusion attributed to intracranial atherosclerosis a systematic review and meta analysis |
| topic | angioplasty ICAD intracranial atheroscelrosis mechanical thrombectomy rescue therapy stenting |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000510 |
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