625 EFFICACY OF MYOTOMY IN PATIENTS WITH SIGMOID MEGAESOPHAGUS: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Marina Orlandini ◽  
Maria Carolina Serafim ◽  
Letícia Datrino ◽  
Clara Santos ◽  
Luca Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heller Myotomy ◽  
Selection Process ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Manual Search ◽  
The Mean

Abstract   Megaesophagus progress to sigmoid megaesophagus (SM) in 10–15% of patients, presenting tortuosity and sigmoid colon aspect. Esophagectomy is the choice treatment but is associated with high complications and mortality rates. To avoid the esophagectomy inherent morbidity, several authors recommend Heller myotomy (HM) with pull-down technique for SM, mainly for patients with comorbidities and the elderly. This systematic review and meta-analysis is the first to analyze the effectiveness of HM for treating SM. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, Lilacs (BVS), and manual search of references. Inclusion criteria were: a) clinical trials, cohort studies, case series; b) patients with SM and esophageal diameter ≥ 6 cm; and c) patients undergoing primary myotomy. The exclusion criteria were: a) reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; b) animal studies, c) previous surgical treatment for achalasia; and d) pediatric studies. There were no restrictions on language or date of publication, and no filters were applied for the selection process. Random model and a 95% confidence interval (CI) were used. Results Sixteen articles were selected, encompassing 231 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. The analyzed outcomes include mortality, complications (pneumonia, pneumothorax, gastroesophageal reflux), need for reintervention (remyotomy, dilation and esophagectomy), and results classified as ‘good’ and ‘excellent’. Mortality rate was 0.035 (CI: 0.017–0.07; p < 0.01). Complications rate was 0.08 (CI: 0.04–0.153; p = 0.01). Need for retreatment rate was 0.161 (CI: 0.053–0.399; p < 0.01). Probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.693–0.819; p < 0,01). Conclusion Heller myotomy is an option for avoiding esophagectomy in achalasia, with a low morbimortality rate and good results. It is effective for most patients but will fail in a minority of patients and demand retreatment, be it a remyotomy, endoscopic treatment or esophagectomy.

scholarly journals Myotomy in sigmoid megaesophagus: is it applicable? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Marina Feliciano Orlandini ◽  
Maria Carolina Andrade Serafim ◽  
Letícia Nogueira Datrino ◽  
Guilherme Tavares ◽  
Luca Schiliró Tristão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Postoperative Mortality ◽  
Perioperative Outcomes ◽  
Manual Search ◽  
The Mean

Summary Introduction: Achalasia may evolve to sigmoid megaesophagus in 10–15% of patients and is usually treated with esophagectomy, which has high morbi-mortality. Many surgeons debate the applicability of the Heller myotomy for treating sigmoid megaesophagus. This study intents to analyze the effectiveness of myotomy for treating patients with sigmoid megaesophagus. Methods: A systematic review and meta-analysis was conducted in PubMed, Cochrane, Lilacs and Embase alongside manual search of references. The inclusion criteria were clinical trials, cohort, case-series; patients with sigmoid megaesophagus and esophageal diameter ≥ 6 cm; and patients undergoing primary myotomy. The exclusion criteria were reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; previous surgical treatment for achalasia; and pediatric or animal model studies. No restrictions on language and date of publication, and no filters were applied. Subgroups analyses were performed to assess the laparoscopic myotomy perioperative outcomes. Besides, subgroup analyses were performed to assess the long-term outcomes of the studies with a follow-up time > 24 months. To verify heterogeneity, the I2 test was used. The random effects were applied, and the fixed model was evaluated as sensitivity analysis. To assess risk of bias and certainty of evidence, the tools ROBINS-I and GRADE were used, respectively. Registration number: CRD42020199667. Results: Sixteen articles were selected, encompassing 350 patients. The mean age ranged from 36 to 61 years old, and the mean follow-up ranged from 16 to 109 months. Complications rate was 0.08 (CI: 0.040–0.153; P = 0.01). Need for retreatment rate was 0.128 (CI: 0.031–0.409; P = 0.01). The probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.703–0.812; P < 0.01). Postoperative mortality rate was 0.008 (CI: 0.004–0.015; P < 0.01). Conclusion: Surgical myotomy is an option for avoiding esophagectomy in achalasia, with a low morbi-mortality rate and good results. It is effective for most patients and only a minority will demand retreatment.

scholarly journals Repurposing of drugs for Covid-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Pinky Kotecha ◽  
Alexander Light ◽  
Enrico Checcucci ◽  
Daniele Amparore ◽  
Cristian Fiori ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Adverse Events ◽  
Clinical Improvement ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Control Group ◽  
Significant Difference

AbstractObjectiveThe aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or placebo.MethodsWe searched Ovid-MEDLINE, EMBASE, Cochrane library, clinical trial registration site in the UK(NIHR), Europe (clinicaltrialsregister.eu), US (ClinicalTrials.gov) and internationally (isrctn.com), and reviewed the reference lists of articles for eligible articles published up to April 22, 2020. All studies in English that evaluated the efficacy of the listed drugs were included. Cochrane RoB 2.0 and ROBINS-I tool were used to assess study quality. This systematic review adheres to the PRISMA guidelines. The protocol is available at PROSPERO (CRD42020180915).ResultsFrom 708 identified studies or clinical trials, 16 studies and 16 case reports met our eligibility criteria. Of these, 6 were randomized controlled trials (763 patients), 7 cohort studies (321 patients) and 3 case series (191 patients). Chloroquine (CQ) had a 100% discharge rate compared to 50% with lopinavir-ritonavir at day 14, however a trial has recommended against a high dosage due to cardiotoxic events. Hydroxychloroquine (HCQ) has shown no significant improvement in negative seroconversion rate which is also seen in our meta-analysis (p=0.68). Adverse events with HCQ have a significant difference compared to the control group (p=0.001). Lopinavir-ritonavir has shown no improvement in time to clinical improvement which is seen in our meta-analyses (p=0.1). Remdesivir has shown no significant improvement in time to clinical improvement but this trial had insufficient power.DiscussionDue to the paucity in evidence, it is difficult to establish the efficacy of these drugs in the treatment of Covid-19 as currently there is no significant clinical effectiveness of the repurposed drugs. Further large clinical trials are required to achieve more reliable findings. A risk-benefit analysis is required on an individual basis to weigh out the potential improvement in clinical outcome and viral load reduction compared to the risks of the adverse events. (1-16)

scholarly journals Incidence of acute pulmonary embolism among patients hospitalized with COVID-19: a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1489
Author(s):  
Mohamed S. Munner ◽  
Charles A. Ritchie ◽  
Ibrahim H. Elkhidir ◽  
Doaa T. Mohammadat ◽  
Hussein J. Ahmed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Assessment Tool ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cross Sectional ◽  
Incidence Data ◽  
Study Heterogeneity ◽  
Newcastle Ottawa Scale

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). .The incidence of PE was noted to be higher in males. The D-dimer levels were specified between PE group and non-PE group in only three studies, while the remaining either reported it improperly or had missing data.The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p<0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.

scholarly journals Influence of Radiofrequency Electromagnetic Fields on the Fertility System: Protocol for a Systematic Review and Meta-Analysis (Preprint)

2017 ◽  
Author(s):  
Nasibeh Roozbeh ◽  
Fatemeh Abdi ◽  
Azadeh Amraee ◽  
Zahra Atarodi Kashani ◽  
Leili Darvish
Keyword(s):  
Systematic Review ◽  
Electromagnetic Fields ◽  
Mobile Phones ◽  
Reproductive System ◽  
Case Reports ◽  
Meta Analysis ◽  
Harmful Effect ◽  
Case Series ◽  
Cochrane Library ◽  
Evidence Based

BACKGROUND Due to the increased number of users of mobile phones, tablets, and other devices over the past few years, concerns about the potential impact of mobile phones on health are growing. The influence of mobile phone exposure on male fertility has been studied in recent years. Other research has shown that electromagnetic fields (EMFs) increase macrophages in the corpus luteum and growing follicles. Due to conflicting results among studies and since no systematic review has been performed to analyze the effects of radiofrequency EMF exposure from electronic devices on the fertility system in recent years, this evidence-based study is necessary. OBJECTIVE The main objectives of this study are to determine the best evidence associated with the influence of radiofrequency EMFs on the fertility system and to provide insight into a potential mechanism using our observations. METHODS In this systematic review, the databases and gray literature will be searched with no language and date limitation. The following databases will be searched: Cochrane Library, MEDLINE, PubMed, EMBASE, CINAHL, ProQuest, Scopus, Science Direct, Google Scholar, and other Persian databases. The combination of the Medical Subject Heading terms “radiofrequency electromagnetic” and “male reproductive system” or “female reproductive system” will be searched. Observational study designs will be included but case reports, case series, reviews, and letters to the editor will be excluded. Papers selected for retrieval will be evaluated by two independent referees for methodological validation before entering a review using the Newcastle-Ottawa Scale for nonrandomized studies and cohort studies. RESULTS The results of this study will be submitted to a peer-reviewed journal for publication and also presented at PROSPERO. CONCLUSIONS This systematic review will provide evidence-based data on the effect of radiofrequency EMFs on the fertility system. This article will also classify the harmful effect of radiofrequency waves on primary and secondary infertility. This study could be useful for decreasing infertility. This is important because the rate of infertility is growing, leading to negative outcomes for couples and the health care system. CLINICALTRIAL PROSPERO CRD42017072462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=72462 (Archived by WebCite at http://www.webcitation.org/6wjiE9R2q)

scholarly journals Influence of Chronic Exposure to Exercise on Heart Rate Variability in Children and Adolescents Affected by Obesity: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (21) ◽  
pp. 11065
Author(s):  
Rodrigo M. Dias ◽  
Íbis A. P. Moraes ◽  
Maria T. A. P. Dantas ◽  
Deborah C. G. L. Fernani ◽  
Anne M. G. G. Fontes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Children And Adolescents ◽  
Chronic Exposure ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cochrane Library ◽  
Mesh Terms

Background: Sedentary lifestyles are increasingly common amongst children, and insufficient physical activity is a global epidemic estimated to contribute to future incapacities and potential deaths. Objective: We aimed to increase the amount of evidence concerning the effect of chronic exposure to exercise on heart rate variability in children and adolescents affected by obesity. Methods: A systematic review commenced following the PRISMA guidelines developed by Web of Science, Virtual Health Library, PubMed, Cochrane Library, Embase, Ovid, Medline Complete, and Scopus using keywords obtained from the Descriptors in Health Sciences and Medical Subject Headlines (MeSH) terms. We considered (1) Population: Pediatric individuals affected by obesity; (2) Intervention: Exercise; (3) Control: Pre-intervention and sedentary; (4) Outcomes: Clearly presented primary parameters; and (5) Studies: Clinical trials, case controls, case reports, and case series. Results: 11 articles were involved and predominantly included procedures observed during approximately 12 weeks with a distribution of three sessions per week, each session being 30–60 min of aerobic exercise; additionally, the exercise grades were typically completed at a percentage of subjects’ maximum heart rates. The meta-analyses displayed a significant effect on the domains of time (R-R interval, SDNN, rMSSD), frequency (HF ms2, HF (n.u.), LF/HF), and the non-linear index (SD1). Conclusion: Chronic exposure to exercise influences heart rate variability in children and adolescents affected by obesity by elevating the variability and parasympathetic activity and improving the sympathetic-vagal balance. Exercises should be recommended for the improvement of cardiac autonomic modulation to prevent the likelihood of further chronic diseases.

scholarly journals Serial interval and incubation period of COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muluneh Alene ◽  
Leltework Yismaw ◽  
Moges Agazhe Assemie ◽  
Daniel Bekele Ketema ◽  
Wodaje Gietaneh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Incubation Period ◽  
Meta Analysis ◽  
Random Effect ◽  
Public Health Intervention ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Serial Interval ◽  
The Mean

Abstract Background Understanding the epidemiological parameters that determine the transmission dynamics of COVID-19 is essential for public health intervention. Globally, a number of studies were conducted to estimate the average serial interval and incubation period of COVID-19. Combining findings of existing studies that estimate the average serial interval and incubation period of COVID-19 significantly improves the quality of evidence. Hence, this study aimed to determine the overall average serial interval and incubation period of COVID-19. Methods We followed the PRISMA checklist to present this study. A comprehensive search strategy was carried out from international electronic databases (Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library) by two experienced reviewers (MAA and DBK) authors between the 1st of June and the 31st of July 2020. All observational studies either reporting the serial interval or incubation period in persons diagnosed with COVID-19 were included in this study. Heterogeneity across studies was assessed using the I2 and Higgins test. The NOS adapted for cross-sectional studies was used to evaluate the quality of studies. A random effect Meta-analysis was employed to determine the pooled estimate with 95% (CI). Microsoft Excel was used for data extraction and R software was used for analysis. Results We combined a total of 23 studies to estimate the overall mean serial interval of COVID-19. The mean serial interval of COVID-19 ranged from 4. 2 to 7.5 days. Our meta-analysis showed that the weighted pooled mean serial interval of COVID-19 was 5.2 (95%CI: 4.9–5.5) days. Additionally, to pool the mean incubation period of COVID-19, we included 14 articles. The mean incubation period of COVID-19 also ranged from 4.8 to 9 days. Accordingly, the weighted pooled mean incubation period of COVID-19 was 6.5 (95%CI: 5.9–7.1) days. Conclusions This systematic review and meta-analysis showed that the weighted pooled mean serial interval and incubation period of COVID-19 were 5.2, and 6.5 days, respectively. In this study, the average serial interval of COVID-19 is shorter than the average incubation period, which suggests that substantial numbers of COVID-19 cases will be attributed to presymptomatic transmission.

scholarly journals Evaluation of the clinical effectiveness of miniscrews in class I and II malocclusion patients

2021 ◽  
Vol 20 ◽  
pp. e213795
Author(s):  
Ali Amiri ◽  
Setareh Khosravi ◽  
Abolfazl Habibi Arbastan ◽  
Sara Jafarizadeh
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Fixed Effect Model ◽  
Class I ◽  
Cochrane Library ◽  
Manual Search ◽  
The Mean ◽  
Mean Differences

Aim: The present systematic review and meta-analysis aimed to evaluate the clinical effectiveness of miniscrews in Class I and II Malocclusion Patients. Methods: From electronic databases, between 2010 and 2020, PubMed, Embase, Cochrane Library, ISI were used to conduct systematic literature. Two reviewers extracted data blindly and independently from the abstract and full text of the studies they used for data extraction. The mean differences between the two groups (miniscrews vs. conventional anchorage) with a 95 % confidence interval (CI), the Inverse-variance method, and the fixed-effect model were calculated. The Meta-analysis was evaluated using the statistical software Stata/MP v.16 (The fastest version of Stata). Results: A total of 186 potentially relevant titles and abstracts were found during the electronic and manual search. Finally, the inclusion criteria required for this systematic review were met by a total of seven publications. The mean difference of molar mesiodistal movement among seven studies and heterogeneity was -0.53 mm (MD, -0.53 95 % CI -0.69, -0.38. P= 0.00) (I2 = 96.52 %). This result showed maximum reinforcement in miniscrews with fewer mesial movements. Conclusion: The result of the current systematic review and meta-analysis shows that miniscrews in patients with class II and I malocclusion help maintain better anchorage preservation than traditional anchorage devices.     

scholarly journals Assessment of the Possibility of Vertical Transmission of COVID-19: A Systematic Review and Meta-analysis Protocol

2021 ◽  
Vol 11 (2) ◽  
pp. 71-76
Author(s):  
Sareh Dashti ◽  
◽  
Tahereh Fathi Najafi ◽  
Hamid Reza Tohidinik ◽  
Narjes Bahri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Vertical Transmission ◽  
Health Care Providers ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Bibliographic Databases ◽  
Care Providers ◽  
Case Control Studies ◽  
Cross Sectional

Background: The Coronavirus disease 2019 (COVID-19) outbreak has put a great burden on global health and healthcare systems. There is controversy regarding the possibility of vertical transmission of COVID-19. This proposed systematic review will be done to assess the possibility of vertical transmission of COVID-19 based on currently published literature. Methods: In this study, all published observational studies, including cross-sectional, cohort, and case-control studies, as well as case reports and case series, in peer-reviewed journals in any language until the end of July 2020 will be assessed. Editorials, commentaries, and letters to editors will be excluded from the review. Searching will be conducted using international bibliographic databases, including PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. The search strategy will be improved and finalized based on the results of the primary search. Data extraction of the included articles will be performed by two researchers using the Zotero and review manager (revMan) software. The heterogeneity of the articles will be assessed using DerSimonian & Laird Q test and I2 statistic. The pooled estimated prevalence of vertical transmission of COVID-19 will be performed using the Metaprop command. Publication bias will be assessed using Begg’s rank correlation and the Egger weighted regression methods Results: Based on the reviewers comments the results section was deleted because this manuscript was a systematic review protocol. Conclusion: The findings of this study will help practitioners and health care providers in decision-making for the care and management of COVID-19-infected pregnant women.

scholarly journals Incidence of acute pulmonary embolism among patients hospitalized with COVID-19: a systematic review and meta-analysis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1489
Author(s):  
Mohamed S. Munner ◽  
Charles A. Ritchie ◽  
Ibrahim H. Elkhidir ◽  
Doaa T. Mohammadat ◽  
Hussein J. Ahmed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Assessment Tool ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Cross Sectional ◽  
Incidence Data ◽  
Study Heterogeneity ◽  
Newcastle Ottawa Scale

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic, which is associated with venous thromboembolism and pulmonary embolism (PE). This study aimed to estimate the pooled incidence of PE among patients hospitalized with COVID-19 within the published literature. Methods: This systematic review and meta-analysis was performed according to PRISMA guidelines. An electronic search using MEDLINE /PubMed, ScienceDirect, Cochrane, and OpenGray databases was conducted May 19th, 2020. Search terms included "COVID 19", "SARS-CoV-2”, "coronavirus disease 2019", "2019-nCoV", "Wuhan coronavirus", “Pulmonary embolism”, "pulmonary thromboembolism", “Pulmonary embol*”, “pulmonary thrombo*” and “PE”. Eligible studies included sufficient data to calculate the incidence of PE diagnosed during hospitalization in patients with COVID-19. Case reports were excluded. Quality was assessed using the Newcastle-Ottawa scale (observational cohort and case-control), AXIS tool (cross-sectional), and quality assessment tool (case series). Demographics and PE incidence data were extracted from the included studies and analyzed with R language. The pooled incidence of PE in patients hospitalized with COVID-19 was calculated. Results: The database search identified 128 records. Ten observational studies were eligible and were included in the meta-analysis with a total of 1722 patients (mean age= 63.36). The pooled PE incidence in patients hospitalized with COVID-19 was 17% (95% CI: 0.1-0.26). There was a high degree of study heterogeneity (I2 = 94%, p<0.01). Conclusion: The pooled PE incidence in patients hospitalized with COVID-19 is 17%. This increased incidence is greater than that previously reported in the general population of non-COVID-19. Attention and further investigation of this risk is warranted.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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