Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials
Introduction Background: Patients with acute strokes with large infarct size are traditionally excluded from endovascular therapies, as like as clinical care. However, questions remain with respect to the safety and efficacy of EVT in these patients. Methods We conducted a meta‐analysis based on poo...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.230 |
| _version_ | 1797221232174694400 |
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| author | Mohammad Hossein Abbasi Ashkan Shoamanesh David S. Liebeskind Steven Warach Hamidreza Saber |
| author_facet | Mohammad Hossein Abbasi Ashkan Shoamanesh David S. Liebeskind Steven Warach Hamidreza Saber |
| author_sort | Mohammad Hossein Abbasi |
| collection | DOAJ |
| description | Introduction Background: Patients with acute strokes with large infarct size are traditionally excluded from endovascular therapies, as like as clinical care. However, questions remain with respect to the safety and efficacy of EVT in these patients. Methods We conducted a meta‐analysis based on pooled data from SELECT 2 trial [1], ANGEL‐ASPECT trial [2], RESCUE Japan [3], and HERMES study [4]. We explored the efficacy of EVT for large infarcts to achieve a favorable 90‐day modified Rankin Scale. Also, we compared favorable outcomes following EVT in those with a core infarct at baseline of more than 70 ml, delayed thrombectomy of more than 6 hours, older than 75 years, and those who received concomitant IV thrombolysis. We also examined the pooled rate of hemorrhagic transformation following EVT in large core strokes. Results This meta‐analysis showed a statistically significant higher rate of favorable outcome in subjects with extremely large infarct size who undergone EVT compared to those who were managed by medical therapy alone (RR: 1.41, 95% CI: [1.05‐1.98], p: 0.03). In the subgroups of patients with core size > 70ml (RR: 1.51, 95% CI: [1.23‐1.87]), late window presentation (LKN to randomization ≥ 6 hours), (RR: 1.53, 95% CI: [1.27‐1.84]), or those 75 or older than 75 years old (RR: 1.43, 95% CI: [1.12‐1.84]), EVT was associated with higher rates of favorable 90‐day mRS score of 0‐3 compared to medical therapy alone. However, EVT was not associated with better outcomes in those who received IV thrombolysis (RR: 1.37, 95% CI: [0.93‐2.01]. Based on pooled data from SELECT‐2, ANGEL‐ASPECT, and RESCUE Japan trials, the overall rate of early symptomatic hemorrhagic transformation among cases with ASPECT 0‐5 in the thrombectomy group was not significantly higher compared to patients who were managed non‐surgically (OR 1.75, 95% CI: [0.89‐3.47]). Conclusion Endovascular therapy is a reasonable option for the management of large infarcts. EVT results in favorable outcome by a delayed thrombectomy for a large core infarct and in older patients. |
| first_indexed | 2024-03-07T15:37:54Z |
| format | Article |
| id | doaj.art-b3216eebed48454f8930866c86287e20 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-04-24T13:02:10Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-b3216eebed48454f8930866c86287e202024-04-05T10:51:58ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-11-013S210.1161/SVIN.03.suppl_2.230Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trialsMohammad Hossein Abbasi0Ashkan Shoamanesh1David S. Liebeskind2Steven Warach3Hamidreza Saber4University of Texas at Austin Texas United StatesMcMaster University / Population Health Research Institute Hamilton CanadaUCLA Stroke Center UCLA California United StatesUniversity of Texas at Austin Dell Medical School Austin Texas United StatesUniversity of Texas at Austin Dell Medical School Austin Texas United StatesIntroduction Background: Patients with acute strokes with large infarct size are traditionally excluded from endovascular therapies, as like as clinical care. However, questions remain with respect to the safety and efficacy of EVT in these patients. Methods We conducted a meta‐analysis based on pooled data from SELECT 2 trial [1], ANGEL‐ASPECT trial [2], RESCUE Japan [3], and HERMES study [4]. We explored the efficacy of EVT for large infarcts to achieve a favorable 90‐day modified Rankin Scale. Also, we compared favorable outcomes following EVT in those with a core infarct at baseline of more than 70 ml, delayed thrombectomy of more than 6 hours, older than 75 years, and those who received concomitant IV thrombolysis. We also examined the pooled rate of hemorrhagic transformation following EVT in large core strokes. Results This meta‐analysis showed a statistically significant higher rate of favorable outcome in subjects with extremely large infarct size who undergone EVT compared to those who were managed by medical therapy alone (RR: 1.41, 95% CI: [1.05‐1.98], p: 0.03). In the subgroups of patients with core size > 70ml (RR: 1.51, 95% CI: [1.23‐1.87]), late window presentation (LKN to randomization ≥ 6 hours), (RR: 1.53, 95% CI: [1.27‐1.84]), or those 75 or older than 75 years old (RR: 1.43, 95% CI: [1.12‐1.84]), EVT was associated with higher rates of favorable 90‐day mRS score of 0‐3 compared to medical therapy alone. However, EVT was not associated with better outcomes in those who received IV thrombolysis (RR: 1.37, 95% CI: [0.93‐2.01]. Based on pooled data from SELECT‐2, ANGEL‐ASPECT, and RESCUE Japan trials, the overall rate of early symptomatic hemorrhagic transformation among cases with ASPECT 0‐5 in the thrombectomy group was not significantly higher compared to patients who were managed non‐surgically (OR 1.75, 95% CI: [0.89‐3.47]). Conclusion Endovascular therapy is a reasonable option for the management of large infarcts. EVT results in favorable outcome by a delayed thrombectomy for a large core infarct and in older patients.https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.230 |
| spellingShingle | Mohammad Hossein Abbasi Ashkan Shoamanesh David S. Liebeskind Steven Warach Hamidreza Saber Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials Stroke: Vascular and Interventional Neurology |
| title | Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials |
| title_full | Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials |
| title_fullStr | Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials |
| title_full_unstemmed | Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials |
| title_short | Abstract 230: Endovascular therapy for large core ischemic strokes: Meta‐analysis of randomized clinical trials |
| title_sort | abstract 230 endovascular therapy for large core ischemic strokes meta analysis of randomized clinical trials |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.230 |
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