Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
IntroductionEndovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical th...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.880046/full |
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| author | Antonis Adamou Androniki Gkana Georgios Mavrovounis Eleftherios T. Beltsios Andreas Kastrup Panagiotis Papanagiotou Panagiotis Papanagiotou |
| author_facet | Antonis Adamou Androniki Gkana Georgios Mavrovounis Eleftherios T. Beltsios Andreas Kastrup Panagiotis Papanagiotou Panagiotis Papanagiotou |
| author_sort | Antonis Adamou |
| collection | DOAJ |
| description | IntroductionEndovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical thrombectomy in patients with acute onset ischemic stroke and pre-stroke dependency (PSD) in regard to their clinical outcome and mortality.Materials and MethodsThe MEDLINE, Scopus, and Cochrane Library databases were comprehensively searched with a cut-off date of December 11th, 2021. We performed meta-analysis to investigate the 90-day clinical outcome, the 90-day mortality, and the rate of symptomatic intracerebral hemorrhage (sICH) between the PSD (modified Rankin Scale score ≥ 3) and non-PSD (modified Rankin Scale score = 0–2) groups who underwent EVT for acute onset ischemic stroke.ResultsSix studies were included in the meta-analysis involving 4,543 cases with no PSD and 591 cases with PSD. The non-PSD group showed a statistically significant better clinical outcome at 90 days compared to the PSD group [RR (95% CI) = 1.44 (1.06, 1.85); pz = 0.02]. The non-PSD group demonstrated a statistically significant lower risk of death at 90 days in comparison to the PSD group [RR (95% CI) = 0.45 (0.41, 0.50); pz < 0.01]. Lastly, the rate of sICH was comparable between the two groups [RR (95% CI) = 0.89 (0.64, 1.24); pz = 0.48].DiscussionWe report a higher rate of unfavorable clinical outcome and a higher mortality rate in patients with PSD undergoing EVT compared to those with no previous disability. However, there was a significant proportion of PSD cases who fared well post-procedurally, indicating that PSD patients should not be routinely excluded from mechanical thrombectomy.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284181, identifier: CRD42021284181. |
| first_indexed | 2024-04-14T05:43:56Z |
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| id | doaj.art-87acb4c748624ac491c57f5e8a6d6643 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-14T05:43:56Z |
| publishDate | 2022-04-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-87acb4c748624ac491c57f5e8a6d66432022-12-22T02:09:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-04-011310.3389/fneur.2022.880046880046Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-AnalysisAntonis Adamou0Androniki Gkana1Georgios Mavrovounis2Eleftherios T. Beltsios3Andreas Kastrup4Panagiotis Papanagiotou5Panagiotis Papanagiotou6Department of Radiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GreeceDepartment of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GreeceDepartment of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GreeceDepartment of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, GreeceDepartment of Neurology, Hospital Bremen-Mitte, Bremen, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, GermanyFirst Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, GreeceIntroductionEndovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical thrombectomy in patients with acute onset ischemic stroke and pre-stroke dependency (PSD) in regard to their clinical outcome and mortality.Materials and MethodsThe MEDLINE, Scopus, and Cochrane Library databases were comprehensively searched with a cut-off date of December 11th, 2021. We performed meta-analysis to investigate the 90-day clinical outcome, the 90-day mortality, and the rate of symptomatic intracerebral hemorrhage (sICH) between the PSD (modified Rankin Scale score ≥ 3) and non-PSD (modified Rankin Scale score = 0–2) groups who underwent EVT for acute onset ischemic stroke.ResultsSix studies were included in the meta-analysis involving 4,543 cases with no PSD and 591 cases with PSD. The non-PSD group showed a statistically significant better clinical outcome at 90 days compared to the PSD group [RR (95% CI) = 1.44 (1.06, 1.85); pz = 0.02]. The non-PSD group demonstrated a statistically significant lower risk of death at 90 days in comparison to the PSD group [RR (95% CI) = 0.45 (0.41, 0.50); pz < 0.01]. Lastly, the rate of sICH was comparable between the two groups [RR (95% CI) = 0.89 (0.64, 1.24); pz = 0.48].DiscussionWe report a higher rate of unfavorable clinical outcome and a higher mortality rate in patients with PSD undergoing EVT compared to those with no previous disability. However, there was a significant proportion of PSD cases who fared well post-procedurally, indicating that PSD patients should not be routinely excluded from mechanical thrombectomy.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284181, identifier: CRD42021284181.https://www.frontiersin.org/articles/10.3389/fneur.2022.880046/fullacute ischemic strokeendovascular thrombectomypre-stroke disabilitysystematic reviewmeta-analysis |
| spellingShingle | Antonis Adamou Androniki Gkana Georgios Mavrovounis Eleftherios T. Beltsios Andreas Kastrup Panagiotis Papanagiotou Panagiotis Papanagiotou Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis Frontiers in Neurology acute ischemic stroke endovascular thrombectomy pre-stroke disability systematic review meta-analysis |
| title | Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_full | Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_fullStr | Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_short | Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis |
| title_sort | outcome of endovascular thrombectomy in pre stroke dependent patients with acute ischemic stroke a systematic review and meta analysis |
| topic | acute ischemic stroke endovascular thrombectomy pre-stroke disability systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.880046/full |
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