Abstract 664: Cerebrovascular Events in Patients Undergoing Endovascular Aortic Repair (EVAR) versus Open Aortic Repair (OAR) for Abdominal Aortic Aneurysm (AAA): A Pooled Meta-Analysis of 10,409 Patients

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Ahmed S Ansari ◽  
Francisco Y Macedo ◽  
Vu Hoang ◽  
Johanna P Contreras ◽  
Yochai Birnbaum ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effects Model ◽  
Randomized Control Trials ◽  
Inclusion Criteria ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Cerebrovascular Events ◽  
Open Aortic Repair ◽  
Significant Difference ◽  
Randomized Control

Background: EVAR is still a relatively new modality for AAA repair and there are not many studies on the complications and risks associated with this procedure. In particular, there is a paucity of data in regards to the risks of Cerebrovascular Events (CVE). The purpose of the paper is to discuss the risks of CVE in patients who have undergone EVAR versus patients that have undergone OAR. We aimed to do a systematic review and meta-analysis of the CVE rates in patients undergoing EVAR versus OAR. Methods: Studies were included if they reported CVE outcomes comparing EVAR versus OAR in patients who underwent AAA repair. Of the 51 unique citations identi[[Unable to Display Character: fi]]ed after the initial literature search and supplementary hand-searches, 10 studies comparing EVAR and OAR who underwent AAA repair met our inclusion criteria. Results were independently extracted by 2 reviewers. A random effects model was applied. The primary end was the incidence of stroke. Results: A total of 10 studies and 10,409 patients were included. Of the 10,409 patients, 2,659 patients underwent EVAR and 7,750 patients underwent OAR. The incidence of CVE in patients undergoing EVAR was 1.01% and the incidence of CVE in patients undergoing OAR was 1.03%. CVE (RR 0.83; CI 0.51-1.34; P=0.44; figure 1) were not statistically significant between patients undergoing EVAR vs OAR. Conclusion: This meta-analysis found that in patients undergoing EVAR versus patients going OAR, there was not a statistically significant difference and EVAR can be as safe as OAR regarding stroke related complications. These findings need to be confirmed with larger randomized control trials.

EXPRESS: Comparison of Mothership versus Drip-and-Ship Models in treating patients with Acute Ischemic Stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110132
Author(s):  
Ahmed Mohamed ◽  
Nida Fatima ◽  
Ashfaq Shuaib ◽  
Maher Saqqur
Keyword(s):  
Functional Outcome ◽  
Meta Analysis ◽  
Critical Time ◽  
Functional Independence ◽  
Models Of Care ◽  
Randomized Control Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control

Introduction There is controversy if direct to comprehensive center “mothership” (MS) or stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and- ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared. Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care. Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

Complications of transradial versus transfemoral access for neuroendovascular procedures: a meta-analysis

2021 ◽  
pp. neurintsurg-2021-018032
Author(s):  
Derrek Schartz ◽  
Sajal Medha K Akkipeddi ◽  
Nathaniel Ellens ◽  
Redi Rahmani ◽  
Gurkirat Singh Kohli ◽  
...  
Keyword(s):  
Literature Review ◽  
Meta Analysis ◽  
Final Analysis ◽  
Case Control ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Access Site ◽  
Lower Odds ◽  
Significant Difference ◽  
Study Heterogeneity

BackgroundTransradial access (TRA) has gained increased usage among neurointerventionalists. However, the overall safety profile of access site complications (ASCs) and non-access site complications (NASCs) of TRA versus transfemoral access (TFA) for neuroendovascular procedures remains unclear.MethodsA systematic literature review and meta-analysis using a random effects model was conducted to investigate the pooled odds ratios (OR) of ASCs and NASCs. Randomized, case–control, and cohort studies comparing access-related complications were analyzed. An assessment of study heterogeneity and publication bias was also completed.ResultsSeventeen comparative studies met the inclusion criteria for final analysis. Overall, there was a composite ASC rate of 1.8% (49/2767) versus 3.2% (168/5222) for TRA and TFA, respectively (P<0.001). TRA was associated with a lower odds of ASC compared with TFA (OR 0.42; 95% CI 0.25 to 0.68, P<0.001, I2=31%). There was significantly lower odds of complications within the intervention and diagnostic subgroups. For NASC, TRA had a lower composite incidence of complications than TFA at 1.2% (31/2586) versus 4.2% (207/4909), P<0.001). However, on meta-analysis, we found no significant difference overall between TRA and TFA for NASCs (OR 0.79; 95% CI 0.51 to 1.22, P=0.28, I2=0%), which was also the case on subgroup analysis.ConclusionOn meta-analysis, the current literature indicates that TRA is associated with a lower incidence of ASCs compared with TFA, but is not associated with a lower rate of NASCs.

scholarly journals The Effectiveness and Safety of Metronomic Chemotherapy in Patients with Head and Neck Carcinoma: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Xingli Li ◽  
Jianjian Wang ◽  
Ting Zhang ◽  
Jiabin Wang ◽  
Zhangcai Zheng ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Metronomic Chemotherapy ◽  
Head And Neck Carcinoma ◽  
Randomized Control Trials ◽  
Neck Carcinoma ◽  
Significant Difference ◽  
Randomized Control

Abstract Background: Head and neck carcinoma, usually begins in the squamous cells, not only seriously endangers the quality of life, but brings a heavy financial burden for families and countries. Metronomic chemotherapy, a frequent administration of chemotherapeutic agents at a non-toxic dose, gives an alternative low-cost and tolerated approach for patients. We conducted a systematic review to find the effectiveness and safety of metronomic chemotherapy for head and neck cancer.Methods: We searched seven databases and Clinical.gov from the inception to July 14, 2021. The patients diagnosed head and neck cancer and older than 18 were included. Metronomic chemotherapy was defined as intervention. Randomized and non-randomized trials were all included. Quality assessment of included randomized control trials was performed using the Cochrane Risk-of-Bias criteria, cohort studies using The Newcastle-Ottawa Scale (NOS), single arm trials using the checklist recommended by The Agency for Healthcare Research and Quality (AHRQ). Studies were synthetized using a narrative approach. The indicators used for meta-analysis was hazard ratio (HR).Results: 310 Literatures were potentially eligible from 7 databases, finally 13 records were included. Five studies were of high quality, while eight were of moderate quality. The overall effect of HR for death of five trials reported had no statistically significant (HR=0.89, 95%CI 0.71-1.10). Subgroup analysis by different design showed a statistically significant HR (0.73, 95%CI 0.60-0.90) in randomized control trials while no significant difference in subgroup of prospective study design (HR=1.23, 95%CI 0.72-2.10). As for HR for PFS, there was no significant difference in overall effect of four studies. HR for PFS was 0.84 (95%CI 0.55-1.31). Subgroup analysis of study design showed that randomized control trials produced a significant HR (0.54, 95%CI 0.45-0.64), while prospective studies did not (1.25, 95%CI 0.73, 2.14).Conclusions: Metronomic chemotherapy has been an optimistic option for treatment for advanced head and neck cancer, especially in low income and medical resource-restricted regions.

scholarly journals The global prevalence of familial multiple sclerosis: an updated systematic review and meta-analysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naeim Ehtesham ◽  
Maryam Zare Rafie ◽  
Meysam Mosallaei
Keyword(s):  
Multiple Sclerosis ◽  
Web Of Science ◽  
Meta Analysis ◽  
Disease Onset ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Isi Web Of Science ◽  
Pooled Prevalence ◽  
Significant Difference ◽  
Meta Regression

Abstract Background Considering that many recent studies have reported the prevalence of familial multiple sclerosis (FMS), we performed an updated meta-analysis of the worldwide prevalence of FMS by the addition of recent publications. Methods A search in PubMed, Scopus, the ISI Web of Science, and Google Scholar was undertaken up to 20 December 2020. The inclusion criteria were based on the CoCoPop approach (condition, context, and population). Meta-analysis of the qualified studies was conducted by comprehensive meta-analysis ver. 2 software. Results The pooled prevalence of MS in relatives of 16,179 FMS cases was estimated to be 11.8% (95% CI: 10.7–13) based on a random-effects model. The pooled mean age of disease onset in adult probands was calculated to be 28.7 years (95% CI: 27.2 ± 30.2). Regarding 13 studies that reported the data of FMS in pediatrics (n = 877) and adults (n = 6636), the FMS prevalence in pediatrics and adults was 15.5% (95% CI: 13.8–17.4) and 10.8% (95% CI: 8.1–14.2), respectively. The prevalence of FMS in affected males (n = 5243) and females (n = 11,503) was calculated to be 13.7% (95% CI: 10.1–18.2) and 15.4% (95% CI: 10.3–22.4), respectively. The odds ratio of male/female in FMS cases was not statistically significant (OR = 0.9; 95% CI: 0.6–1.2, P = 0.55). Subgroup analysis demonstrated a significant difference in the prevalence of FMS between the geographical areas (P = 0.007). The meta-regression model indicated that the prevalence of FMS is lower with higher latitude and higher MS prevalence (P < 0.001). In contrast, meta-regression based on prevalence day was not statistically significant (P = 0.29). Conclusions The prevalence of FMS is higher in the pediatric group than that of adults, distinct between geographical areas, and diminishes with the increment of MS prevalence and latitude. Also, the symptoms initiate relatively at younger ages in the FMS cases. Interestingly, our analysis unveiled that FMS is not more prevalent in men than women and the risk of MS development in relatives is not higher when the affected proband is male.

Participation based intervention with acquired brain injury: Systematic review and meta-analysis

2020 ◽  
pp. 1-11
Author(s):  
Si-nae Ahn
Keyword(s):  
Systematic Review ◽  
Brain Injury ◽  
Meta Analysis ◽  
Acquired Brain Injury ◽  
Randomized Control Trials ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Rehabilitation Programs ◽  
Randomized Control

Background: Continued long-term rehabilitation programs with acquired brain injury are important for their participation in meaningful daily activities. Objective: This paper investigated the participation-based interventions on outcomes in patients with acquired brain injury. Methods: A systematic review and meta-analysis search for randomized control trials published between 1998 and 2019 using PubMed, CINAHL, and MEDLINE was performed. Nine studies were selected and analyzed for systematic review. Five studies analyzed the effectiveness of participation-based intervention using meta-analysis and assessed the level of evidence of qualitative studies. Results: A total of 843 publications were searched. Nine studies met the inclusion criteria and were of high quality. The effective score for improving participation following participation-based interventions in persons with acquired brain injury was 0.32 and significant in this study (p <  0.05). Conclusions: The findings of this systematic review and meta-analysis suggest that, in persons with acquired brain injury, participation-based interventions are essential for community living.

scholarly journals Meta-analysis of prednisone in withdrawal therapy following medication overuse headache

2021 ◽  
Vol 26 (4) ◽  
pp. 761-766
Author(s):  
Wenmiao Jie ◽  
Jianzhong Xiong ◽  
Xiaohua Yan
Keyword(s):  
Medication Overuse ◽  
Meta Analysis ◽  
Medication Overuse Headache ◽  
Control Group ◽  
Randomized Control Trials ◽  
Significant Difference ◽  
Withdrawal Therapy ◽  
Randomized Control ◽  
Experimental Group

The objective of this meta-analysis was to evaluate the therapeutic effectiveness of prednisone in withdrawal therapy following medication overuse headache. The Cochrane, PubMed, EMBASE, Web of Science, CNKI, VIP, and Wanfang data were searched to identify randomized control trials of prednisone for the treatment of medication overuse headache. Two researchers independently screened published studies according to inclusion and exclusion criteria, and evaluated the methodological quality of included studies. Revman 5.3 software was used to analyze the extracted data, and a total of six randomized control trials involving 510 patients were included in the study. Meta-analysis indicated that there was no significant difference in the ratio of taking painkillers again after withdrawal (RR=0.89, 95% CI: 0.70,1.14, P=0.36) compared with the control group. There was also no significant difference between the experimental group and the control group in the incidence of withdrawal reactions (RR=1.28, 95% CI: 0.87, 1.89, P=0.21), severity of headache (RR=1.56, 95% CI: -4.83, 7.95, P=0. 63) and the frequency of headache attacks after withdrawal (RR=0.14, 95% CI: -0.35, 0.63, P=0.58). It is concluded that prednisone does not alleviate symptoms in patients with medication overuse headache after withdrawal.

scholarly journals Lithium carbonate as add-on therapy to radioiodine in the treatment on hyperthyroidism: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohamed Abd-ElGawad ◽  
Mohamed Abdelmonem ◽  
Ahmed Eissa Ahmed ◽  
Omar Magdy Mohammed ◽  
Mohamed Sayed Zaazouee ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Radioactive Iodine ◽  
Meta Analysis ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Randomized Control Trials ◽  
Cure Rate ◽  
Significant Difference ◽  
Randomized Control

Abstract Background The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level. Methods Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Results Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13. Conclusions LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Efficacy and safety of doxycycline for the management of small abdominal aortic aneurysms- a meta analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
D Rocha Castellanos ◽  
A Lopez Mendez ◽  
M Fernando Perez Paz ◽  
S Pothuru ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Abdominal Aortic Aneurysms ◽  
Abdominal Aortic Aneurysm Repair ◽  
Mean Difference ◽  
Aortic Aneurysms ◽  
Efficacy And Safety ◽  
Funding Sources ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
Aneurysm Repair

Abstract Funding Acknowledgements Type of funding sources: None. Background- Patients with small Abdominal Aortic Aneurysms are managed with surveillance as there is currently insufficient evidence to recommend surgical aneurysm repair. Hence, there is a dire need and interest in pharmacotherapy like tetracycline antibiotics to reduce the need for aneurysm repair. Purpose- To determine the efficacy and safety of doxycycline in the management of small abdominal aortic aneurysms. Methods- Electronic databases (PubMed, Scopus, Embase, Cochrane) were searched until 25th November 2020.The primary outcomes were the mean difference (MD) in aneurysm diameter and the odds ratio (OR) calculated to compare the number of individuals referred to Abdominal aortic aneurysm repair in each group. Results- A total of three studies with 572 participants (Doxycycline = 290; Placebo = 282 ) were included in our analysis. Average follow up was a period of 18 months. For AAA expansion, the combined results demonstrated a statistically significant mean difference in expansion rates favoring the placebo groups over the intervention (WMD-0.75, 95%CI 0.12-1.38; p = 0.02;I2 = 0%) There was no statistically significant difference in the efficacy and safety of doxycycline as opposed to placebo groups for referral to AAA surgery (OR 1.01, 95%CI 0.61-1.69; p = 0.96, I2 = 0%) and all-cause mortality(OR 0.51; 95%CI 0.18-1.43; p = 0.20, I2 =0%) Conclusion- Amongst patients with small abdominal aortic aneurysms, doxycycline did not significantly reduce aneurysm growth. Abstract Figure. A) AAA expansion B)Surgery C)Mortality

Sign in / Sign up

Export Citation Format

Share Document