Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy
Background Recent randomized controlled clinical trials have provided solid evidence that mechanical thrombectomy (MT) coupled with best medical therapy (BMT) improve functional outcomes of acute ischemic stroke patients with large vessel occlusion compared with BMT alone. However, they provided inc...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014425 |
| _version_ | 1828953285874155520 |
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| author | Aristeidis H. Katsanos Konark Malhotra Nitin Goyal Lina Palaiodimou Peter D. Schellinger Valeria Caso Charlotte Cordonnier Guillaume Turc Georgios Magoufis Adam Arthur Andrei V. Alexandrov Georgios Tsivgoulis |
| author_facet | Aristeidis H. Katsanos Konark Malhotra Nitin Goyal Lina Palaiodimou Peter D. Schellinger Valeria Caso Charlotte Cordonnier Guillaume Turc Georgios Magoufis Adam Arthur Andrei V. Alexandrov Georgios Tsivgoulis |
| author_sort | Aristeidis H. Katsanos |
| collection | DOAJ |
| description | Background Recent randomized controlled clinical trials have provided solid evidence that mechanical thrombectomy (MT) coupled with best medical therapy (BMT) improve functional outcomes of acute ischemic stroke patients with large vessel occlusion compared with BMT alone. However, they provided inconclusive evidence on the benefit of MT on mortality. Methods and Results We evaluated the association of MT+BMT compared with BMT with the risk of 3‐month mortality using aggregate data from all available randomized controlled clinical trials. We also sought to identify potential predictors on the mortality risk and performed univariate meta‐regression analyses. Our literature search identified 11 eligible randomized controlled clinical trials, including a total of 2460 patients. The pooled rates of 3‐month mortality were 15% (95% CI:12%–19%) and 19% (95% CI:16%–23%), respectively, in the MT+BMT and BMT groups. In the overall analysis MT+BMT was associated with a significantly lower risk for 3‐month mortality compared with BMT (risk ratio=0.83, 95% CI:0.69–0.99; P=0.04), without heterogeneity across included studies (I2=3%, P for Cochran Q=0.41). No evidence of publication bias was present in funnel plot inspection and Egger statistical test (P=0.762). In meta‐regression analyses no moderating effect on the aforementioned association was detected with patient age (P=0.254), sex (P=0.702), admission systolic blood pressure (P=0.601), admission glucose (P=0.277), onset‐to‐groin puncture time (P=0.985), administration of intravenous alteplase before MT (P=0.804), MT under general anesthesia (P=0.735), and successful reperfusion following MT (P=0.663). Conclusions Our meta‐analysis provides evidence that MT+BMT reduces the risk of 3‐month mortality compared with BMT alone. This association appears not to be moderated by individual patient or procedural characteristics. |
| first_indexed | 2024-12-14T07:08:12Z |
| format | Article |
| id | doaj.art-8280c96a04424250a0c9145746c0024e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T07:08:12Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8280c96a04424250a0c9145746c0024e2022-12-21T23:12:04ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182110.1161/JAHA.119.014425Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical ThrombectomyAristeidis H. Katsanos0Konark Malhotra1Nitin Goyal2Lina Palaiodimou3Peter D. Schellinger4Valeria Caso5Charlotte Cordonnier6Guillaume Turc7Georgios Magoufis8Adam Arthur9Andrei V. Alexandrov10Georgios Tsivgoulis11Second Department of Neurology “Attikon” Hospital School of Medicine National and Kapodistrian University of Athens GreeceDepartment of Neurology Allegheny Health Network, Pittsburgh Pennsylvania USADepartment of Neurology University of Tennessee Health Science Center Memphis TNSecond Department of Neurology “Attikon” Hospital School of Medicine National and Kapodistrian University of Athens GreeceDepartment of Neurology and Neurogeriatry Johannes Wesling Medical Center Ruhr University Bochum GermanyStroke Unit University of Perugia ItalyDepartment of Neurology Univ. Lille Inserm U1171 Degenerative & Vascular Cognitive Disorders CHU Lille FranceDepartment of Neurology Hôpital Sainte‐Anne Paris FranceSecond Department of Neurology “Attikon” Hospital School of Medicine National and Kapodistrian University of Athens GreeceDepartment of Neurosurgery University of Tennessee Health Science Center and Semmes‐Murphey Clinic Memphis TNDepartment of Neurology University of Tennessee Health Science Center Memphis TNSecond Department of Neurology “Attikon” Hospital School of Medicine National and Kapodistrian University of Athens GreeceBackground Recent randomized controlled clinical trials have provided solid evidence that mechanical thrombectomy (MT) coupled with best medical therapy (BMT) improve functional outcomes of acute ischemic stroke patients with large vessel occlusion compared with BMT alone. However, they provided inconclusive evidence on the benefit of MT on mortality. Methods and Results We evaluated the association of MT+BMT compared with BMT with the risk of 3‐month mortality using aggregate data from all available randomized controlled clinical trials. We also sought to identify potential predictors on the mortality risk and performed univariate meta‐regression analyses. Our literature search identified 11 eligible randomized controlled clinical trials, including a total of 2460 patients. The pooled rates of 3‐month mortality were 15% (95% CI:12%–19%) and 19% (95% CI:16%–23%), respectively, in the MT+BMT and BMT groups. In the overall analysis MT+BMT was associated with a significantly lower risk for 3‐month mortality compared with BMT (risk ratio=0.83, 95% CI:0.69–0.99; P=0.04), without heterogeneity across included studies (I2=3%, P for Cochran Q=0.41). No evidence of publication bias was present in funnel plot inspection and Egger statistical test (P=0.762). In meta‐regression analyses no moderating effect on the aforementioned association was detected with patient age (P=0.254), sex (P=0.702), admission systolic blood pressure (P=0.601), admission glucose (P=0.277), onset‐to‐groin puncture time (P=0.985), administration of intravenous alteplase before MT (P=0.804), MT under general anesthesia (P=0.735), and successful reperfusion following MT (P=0.663). Conclusions Our meta‐analysis provides evidence that MT+BMT reduces the risk of 3‐month mortality compared with BMT alone. This association appears not to be moderated by individual patient or procedural characteristics.https://www.ahajournals.org/doi/10.1161/JAHA.119.014425ischemic strokemortalitythrombectomy |
| spellingShingle | Aristeidis H. Katsanos Konark Malhotra Nitin Goyal Lina Palaiodimou Peter D. Schellinger Valeria Caso Charlotte Cordonnier Guillaume Turc Georgios Magoufis Adam Arthur Andrei V. Alexandrov Georgios Tsivgoulis Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemic stroke mortality thrombectomy |
| title | Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy |
| title_full | Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy |
| title_fullStr | Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy |
| title_full_unstemmed | Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy |
| title_short | Mortality Risk in Acute Ischemic Stroke Patients With Large Vessel Occlusion Treated With Mechanical Thrombectomy |
| title_sort | mortality risk in acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy |
| topic | ischemic stroke mortality thrombectomy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014425 |
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