Abstract W P26: Meta-analysis Of Studies Using Solitaire And Trevo Pro Stent Retriever Devices For Mechanical Thromboembolectomy In Acute Cerebral Ischemia

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Vikram Jadhav ◽  
Mushtaq H Qureshi ◽  
Malik M Adil ◽  
Amna Zarar ◽  
Nidaullah Mian ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Publication Bias ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Analysis Software ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Acute Cerebral Ischemia ◽  
Random Models ◽  
Log Odds ◽  
Event Rates

Objective: To report rates of recanalization and symptomatic intracerebral hemorrhage (SICH) after mechanical thromboembolectomy using Solitaire and Trevo Pro devices in acute cerebral ischemia using meta-analysis of published studies. Methods: We identified all studies that used Solitaire or Trevo devices for mechanical thromboembolectomy in treatment of acute cerebral ischemia using a search on PubMed and Cochrane libraries, stroke trials database, proceedings of neurology and neurosurgery related conferences, and supplemented by a review of bibliographies of selected publications. Recanalization was assessed using TICI >2a and rates of SICH were recorded. For the meta-analysis, forest plots and statistical analysis including event rates [ER] with 95% confidence intervals [CI] based on both fixed and random models were performed using Comprehensive Meta-Analysis Software. The presence of publication bias was interrogated by funnel plot of Standard Error by log odds ratio. Results: Eighteen studies with Solitaire device and five with Trevo device were identified and included in the meta-analysis. There were a total of 433/505 (85%, ER 0.85 [CI] 0.80-0.88, P<0.001) successful recanalizations with Solitaire device whereas 196/243 (80%, ER 0.80 [CI] 0.74-0.85, P<0.001) successful recanalizations were noted with Trevo device. The incidence of SICH was 45/505 (9%, ER 0.09 [CI] 0.06-0.14, P<0.001) with Solitaire device and 17/243 (6%, ER 0.06 [CI] 0.049-0129, P<0.001) with Trevo device after mechanical thrombectomy. There was no publication bias. Conclusions: Meta-analysis of studies reveals similar rates for recanalization and SICH after mechanical thromboembolectomy using Solitaire or Trevo Pro devices.

scholarly journals Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-analysis of Stent Retrievers Versus Direct Aspiration Versus a Combined Approach

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Theofilos Karasavvidis ◽  
Leonardo Rangel-Castilla ◽  
Dennis J Rivet ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Stent Retriever ◽  
Combined Approach ◽  
First Line ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Rescue Treatment ◽  
Combined Use ◽  
Stent Retrievers ◽  
Event Rates

Abstract INTRODUCTION Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke. Stent retriever thrombectomy, direct aspiration and combined use of a stent retriever and aspiration have been alternatively used.The aim of this study was to compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS This study was performed according to the PRISMA guidelines. A random-effects model meta-analysis was conducted. RESULTS In all 21 studies with a total of 3059 patients were included. No differences were identified between the stent retriever and aspiration group in terms of modified thrombolysis in cerebral infarction (mTICI) 2b/3, mTICI 3 recanalization rates and favorable outcome (mRS = 2). Adverse event rates including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), subarachnoid hemorrhage (SAH), parenchymal hematoma, new territory emboli, arterial dissection and perforation were similar between the stent retriever and direct aspiration group. Use of the stent retriever was associated with a higher risk of vasospasm (OR:2.59; 95% CI: 1.00-6.74; I2:0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent mechanical thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.76; 95% CI:1.23-2.52; I2: 5.5%) and mTICI 3 recanalization (OR: 2.29; 95% CI: 1.08-4.88; I2: 58%) although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32; I2: -). In addition, patients who had thrombectomy with the combined approach as a rescue treatment after failure of first-line aspiration were at a significantly higher risk of sICH (OR: 3.49; 95% CI: 1.20-10.19; I2: 21.7%). CONCLUSION Stent retriever thrombectomy and direct aspiration were equally safe and effective. When compared with direct aspiration, the combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates although with a higher risk of 24-hr SAH.

Mechanical Thrombectomy in Acute Ischemic Stroke: A Meta-Analysis of Stent Retrievers vs Direct Aspiration vs a Combined Approach

Neurosurgery ◽  
2019 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Theofilos Karasavvidis ◽  
Leonardo Rangel-Castilla ◽  
Dennis J Rivet ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Combined Approach ◽  
First Line ◽  
Vessel Occlusion ◽  
Stent Retrieval ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stent Retrievers ◽  
Meta Analyses ◽  
Event Rates

Abstract BACKGROUND Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion. OBJECTIVE To compare the safety and efficacy profile of the different mechanical thrombectomy strategies. METHODS A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32). CONCLUSION Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.

#Fake news: a systematic review of mechanical thrombectomy results among neurointerventional stroke surgeons on Twitter

2018 ◽  
Vol 11 (5) ◽  
pp. 460-463 ◽  
Author(s):  
Adam Andrew Dmytriw ◽  
Thomas Joseph Sorenson ◽  
Jonathan M Morris ◽  
Patrick J Nicholson ◽  
Christopher Alan Hilditch ◽  
...  
Keyword(s):  
Social Media ◽  
Publication Bias ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
National Institutes Of Health ◽  
Post Intervention ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Media Platform

ObjectiveTwitter is a popular social media platform among physicians. Neurointerventionalists frequently document their lifesaving mechanical thrombectomy cases on Twitter with very favorable results. We fear that there may be some social media publication bias to tweeted mechanical thrombectomy cases with neurointerventionalists being more likely to tweet cases with favorable outcomes. We used these publicly documented cases to analyze post-intervention Twitter-reported outcomes and compared these outcomes with the data provided in the gold standard literature.MethodsTwo reviewers performed a search of Twitter for tweeted cases of acute ischemic strokes treated with mechanical thrombectomy. Data were abstracted from each tweet regarding baseline characteristics and outcomes. Twitter-reported outcomes were compared with the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke (HERMES) trial individual patient meta-analysis.ResultsWhen comparing the tweeted results to HERMES, tweeted cases had a higher post-intervention rate of modified Thrombolysis In Cerebral Infarction (mTICI) scale score of 2c/3 (94% vs 71%, respectively; p<0.0001) and rate of National Institutes of Health Stroke Scale (NIHSS) score ≤2 (81% vs 21%, respectively; p<0.0001). There were no reported complications; thus, tweeted cases also had significantly lower rates of complications, including symptomatic intracerebral hemorrhage (0% vs 4.4%, respectively; p<0.0001), type 2 parenchymal hemorrhage (0% vs 5.1%, respectively; p<0.0001), and mortality (0% vs 15.3%, respectively; p<0.0001).ConclusionsThere is a significant difference between social media and reality even within the ‘MedTwitter’ sphere, which is likely due to a strong publication bias in Twitter-reported cases. Content on ‘MedTwitter’, as with most social media, should be accepted cautiously.

scholarly journals Treatment of acute cerebral ischemia using animal models: a meta-analysis

2015 ◽  
Vol 6 (1) ◽  
pp. 47-58 ◽  
Author(s):  
Peng-Fei Wang ◽  
Yu Zhou ◽  
Huang Fang ◽  
Sen Lin ◽  
Yan-Chun Wang ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Animal Models ◽  
Infarct Size ◽  
Receptor Antagonist ◽  
Meta Analysis ◽  
Extensive Literature ◽  
Calmodulin Antagonist ◽  
Occlusion Time ◽  
Acute Cerebral Ischemia ◽  
Sphingosine 1 Phosphate

AbstractBackground: There are numerous potential treatments assessed for acute cerebral ischemia using animal models. This study aimed to assess the effect of these treatments in terms of infarct size and neurobehavioral change. This meta-analysis was conducted to determine if any of these treatments provide a superior benefit so that they might be used on humans. Methods: A systematic search was conducted using several electronic databases for controlled animal studies using only nonsurgical interventions for acute cerebral ischemia. A random-effects model was used. Results: After an extensive literature search, 145 studies were included in the analysis. These studies included 1408 treated animals and 1362 control animals. Treatments that had the most significant effect on neurobehavioral scales included insulin, various antagonists, including N-methyl-Daspartate (NMDA) receptor antagonist ACEA1021, calmodulin antagonist DY-9760e, and α-amino-3-hydroxy-5- methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist YM872, and antiviral agents. Treatments providing the greatest effect on infarct size included statins, sphingosine-1-phosphate agonist (fingolimod), alcohol, angiotensin, and leukotrienes. Treatments offering the greatest reduction in brain water content included various agonists, including sphingosine-1-phosphate agonist fingolimod, statins, and peroxisome proliferator-activated receptor gamma (PPAR-γ). Treatment groups with more than one study all had high heterogeneity (I2 > 80%), however, using meta-regression we determined several sources of heterogeneity including sample size of the treatment and control groups, the occlusion time, but not the year when the study was conducted. Conclusions: Some treatments stand out when compared to others for acute cerebral ischemia in animals. Greater replication of treatment studies is required before any treatments are selected for future human trials.

Analysis of the association of MPO and MMP-9 with stroke severity and outcome

Neurology ◽  
2020 ◽  
Vol 95 (1) ◽  
pp. e97-e108 ◽  
Author(s):  
Ilaria Maestrini ◽  
Madjid Tagzirt ◽  
Sophie Gautier ◽  
Annabelle Dupont ◽  
Anne-Marie Mendyk ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Ex Vivo ◽  
Plasma Concentrations ◽  
Recombinant Tissue Plasminogen Activator ◽  
Hemorrhagic Transformation ◽  
Stroke Severity ◽  
Excellent Outcome ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Acute Cerebral Ischemia ◽  
Neutrophil Degranulation

ObjectiveIn acute cerebral ischemia, circulating neutrophil count and neutrophil-to-lymphocyte ratio (NLR) are positively associated with stroke severity and worse outcomes. Mediators of this effect are unknown. We aimed to investigate (1) the relationship between plasma matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) concentrations with stroke severity and outcome and (2) MMP-9 and MPO release after ex vivo stimulation of neutrophils by recombinant tissue plasminogen activator (rtPA).MethodsWe analyzed data collected in 255 patients with supratentorial cerebral infarcts recruited within 48 hours of symptoms onset irrespective of rtPA treatment. The endpoints were excellent outcome (modified Rankin Scale score 0–1), symptomatic intracerebral hemorrhage (European Cooperative Acute Stroke Study–II definition), and death at 3 months. The role of rtPA treatment on peripheral neutrophil degranulation was investigated in 18 patients within 4.5 hours and after 72 hours.ResultsNeutrophil counts, NLR, and MPO plasma concentrations, but not MMP-9, were positively correlated with stroke severity. Higher neutrophil counts and NLR were independently associated with worse outcomes and higher mortality rates at month 3. Higher MPO plasma concentrations, but not MMP-9, were associated with worse outcome. Neutrophil-derived MMP-9, after ex vivo rtPA stimulation, but not MPO, were higher after 72 hours in patients treated by IV rtPA but not associated with hemorrhagic transformation.ConclusionsNeutrophil counts, NLR, and MPO plasma concentrations are associated with worse outcome in patients with acute cerebral ischemia, in contrast to MMP-9. Further investigations are needed to deepen our knowledge on MPO’s role in the deleterious effect of neutrophils because it could represent a potential therapeutic target.

scholarly journals Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis

2018 ◽  
Vol 11 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Pasquale Mordasini ◽  
Marcel Arnold ◽  
Elena López-Cancio ◽  
Neus Cerdá ◽  
...  
Keyword(s):  
Selection Bias ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Fatal Outcome ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Randomized Controlled Clinical Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Inverse Variance ◽  
Meta Analyses

BackgroundWhether pretreatment with intravenous thrombolysis prior to mechanical thrombectomy (IVT+MTE) adds additional benefit over direct mechanical thrombectomy (dMTE) in patients with large vessel occlusions (LVO) is a matter of debate.MethodsThis study-level meta-analysis was presented in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled effect sizes were calculated using the inverse variance heterogeneity model and displayed as summary Odds Ratio (sOR) and corresponding 95% confidence interval (95% CI). Sensitivity analysis was performed by distinguishing between studies including dMTE patients eligible for IVT (IVT-E) or ineligible for IVT (IVT-IN). Primary outcome measures were functional independence (modified Rankin Scale≤2) and mortality at day 90, successful reperfusion, and symptomatic intracerebral hemorrhage.ResultsTwenty studies, incorporating 5279 patients, were included. There was no evidence that rates of successful reperfusion differed in dMTE and IVT+MTE patients (sOR 0.93, 95% CI 0.68 to 1.28). In studies including IVT-IN dMTE patients, patients undergoing dMTE tended to have lower rates of functional independence and had higher odds for a fatal outcome as compared with IVT+MTE patients (sOR 0.78, 95% CI 0.61 to 1.01 and sOR 1.45, 95% CI 1.22 to 1.73). However, no such treatment group effect was found when analyses were confined to cohorts with a lower risk of selection bias (including IVT-E dMTE patients).ConclusionThe quality of evidence regarding the relative merits of IVT+MTE versus dMTE is low. When considering studies with lower selection bias, the data suggest that dMTE may offer comparable safety and efficacy as compared with IVT+MTE. The conduct of randomized-controlled clinical trials seems justified.

Safety and predictors of stroke mimics in The Norwegian Tenecteplase Stroke Trial (NOR-TEST)

2018 ◽  
Vol 14 (5) ◽  
pp. 508-516 ◽  
Author(s):  
Christopher Elnan Kvistad ◽  
Vojtech Novotny ◽  
Halvor Næss ◽  
Guri Hagberg ◽  
Hege Ihle-Hansen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Ischemia ◽  
Transient Ischemic Attack ◽  
Sensory Loss ◽  
Stroke Mimics ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Acute Cerebral Ischemia ◽  
Stroke Mimic ◽  
Ischemic Attack ◽  
Stroke Trial

Background Stroke mimics are frequently treated with thrombolysis in clinical practice and thrombolytic trials. Although alteplase in stroke mimics has proven to be safe, safety of tenecteplase in stroke mimics has not been assessed in an ischemic stroke study setting. We aimed to assess clinical characteristics and safety of stroke mimics treated with thrombolysis in the Norwegian Tenecteplase Stroke Trial. We also aimed to identify possible predictors of stroke mimics as compared to patients with acute cerebral ischemia. Methods Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with suspected acute cerebral ischemia. Two groups were defined based on diagnose at discharge: patients with a different diagnose than ischemic stroke or transient ischemic attack (stroke mimics group) and patients diagnosed with ischemic stroke or transient ischemic attack (acute cerebral ischemia group). Logistic regression analyses were performed with stroke mimics vs. acute cerebral ischemia as dependent variable to identify predictors of stroke mimics. Results Of 1091 randomized patients, 181 (16.6%) were stroke mimics. Migraine (22.2%) and peripheral vertigo (11.4%) were the two most frequent stroke mimic-diagnoses. There was no symptomatic intracerebral hemorrhage in the stroke mimics group. Stroke mimics were independently associated with age ≤60 years (OR 2.75, p < 0.001), female sex (OR 1.48, p = 0.026), no history of myocardial infarction (OR 2.03, p = 0.045), systolic BP ≤ 150 mmHg (OR 2.33, p < 0.001), NIHSS ≤ 6 points (OR 1.83, p = 0.011), sensory loss (OR 1.55, p = 0.015), and no facial paresis (OR 2.41, p < 0.001) on admission. Conclusion Thrombolysis with tenecteplase seems to be as safe as with alteplase in stroke mimics. Predictors were identified for stroke mimics which may contribute to differentiate stroke mimics from acute cerebral ischemia in future stroke trials.

Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes

2021 ◽  
Vol 13 (3) ◽  
pp. 212-216
Author(s):  
Mehdi Abbasi ◽  
Yang Liu ◽  
Seán Fitzgerald ◽  
Oana Madalina Mereuta ◽  
Jorge L Arturo Larco ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Literature Search ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Neurologic Outcome ◽  
Single Pass ◽  
First Pass Effect ◽  
Symptomatic Intracerebral Hemorrhage ◽  
First Pass ◽  
Good Neurologic Outcome

BackgroundFirst pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes.ObjectiveTo determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE.MethodsIn July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c–3 after a single pass) and modified FPE (mFPE, defined as TICI 2b–3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate.ResultsSixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE).ConclusionsOur findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.

scholarly journals Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review

2016 ◽  
Vol 43 (4) ◽  
pp. 455-460 ◽  
Author(s):  
Anna Lambrinos ◽  
Alexis K. Schaink ◽  
Irfan Dhalla ◽  
Timo Krings ◽  
Leanne K. Casaubon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Clinical Effectiveness ◽  
Functional Independence ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Best Medical Therapy

AbstractAlthough intravenous thrombolysis increases the probability of a good functional outcome in carefully selected patients with acute ischemic stroke, a substantial proportion of patients who receive thrombolysis do not have a good outcome. Several recent trials of mechanical thrombectomy appear to indicate that this treatment may be superior to thrombolysis. We therefore conducted a systematic review and meta-analysis to evaluate the clinical effectiveness and safety of new-generation mechanical thrombectomy devices with intravenous thrombolysis (if eligible) compared with intravenous thrombolysis (if eligible) in patients with acute ischemic stroke caused by a proximal intracranial occlusion. We systematically searched seven databases for randomized controlled trials published between January 2005 and March 2015 comparing stent retrievers or thromboaspiration devices with best medical therapy (with or without intravenous thrombolysis) in adults with acute ischemic stroke. We assessed risk of bias and overall quality of the included trials. We combined the data using a fixed or random effects meta-analysis, where appropriate. We identified 1579 studies; of these, we evaluated 122 full-text papers and included five randomized control trials (n=1287). Compared with patients treated medically, patients who received mechanical thrombectomy were more likely to be functionally independent as measured by a modified Rankin score of 0-2 (odds ratio, 2.39; 95% confidence interval, 1.88-3.04; I2=0%). This finding was robust to subgroup analysis. Mortality and symptomatic intracerebral hemorrhage were not significantly different between the two groups. Mechanical thrombectomy significantly improves functional independence in appropriately selected patients with acute ischemic stroke.

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