scholarly journals Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

Stroke ◽  
2021 ◽  
Author(s):  
Aristeidis H. Katsanos ◽  
Lina Palaiodimou ◽  
Ramin Zand ◽  
Shadi Yaghi ◽  
Hooman Kamel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Mean Difference ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and Purpose: We systematically evaluated the impact of the coronavirus 2019 (COVID-19) pandemic on stroke care across the world. Methods: Observational studies comparing characteristics, acute treatment delivery, or hospitalization outcomes between patients with stroke admitted during the COVID-19 pandemic and those admitted before the pandemic were identified by Medline, Scopus, and Embase databases search. Random-effects meta-analyses were conducted for all outcomes. Results: We identified 46 studies including 129 491 patients. Patients admitted with stroke during the COVID-19 pandemic were found to be younger (mean difference, −1.19 [95% CI, −2.05 to −0.32]; I 2 =70%) and more frequently male (odds ratio, 1.11 [95% CI, 1.01–1.22]; I 2 =54%) compared with patients admitted with stroke in the prepandemic era. Patients admitted with stroke during the COVID-19 pandemic, also, had higher baseline National Institutes of Health Stroke Scale scores (mean difference, 0.55 [95% CI, 0.12–0.98]; I 2 =90%), higher probability for large vessel occlusion presence (odds ratio, 1.63 [95% CI, 1.07–2.48]; I 2 =49%) and higher risk for in-hospital mortality (odds ratio, 1.26 [95% CI, 1.05–1.52]; I 2 =55%). Patients with acute ischemic stroke admitted during the COVID-19 pandemic had higher probability of receiving endovascular thrombectomy treatment (odds ratio, 1.24 [95% CI, 1.05–1.47]; I 2 =40%). No difference in the rates of intravenous thrombolysis administration or difference in time metrics regarding onset to treatment time for intravenous thrombolysis and onset to groin puncture time for endovascular thrombectomy were detected. Conclusions: The present systematic review and meta-analysis indicates an increased prevalence of younger patients, more severe strokes attributed to large vessel occlusion, and higher endovascular treatment rates during the COVID-19 pandemic. Patients admitted with stroke during the COVID-19 pandemic had higher in-hospital mortality. These findings need to be interpreted with caution in view of discrepant reports and heterogeneity being present across studies.

scholarly journals Mechanical thrombectomy versus intravenous thrombolysis for distal large-vessel occlusion: a systematic review and meta-analysis of observational studies

2021 ◽  
Vol 51 (1) ◽  
pp. E5
Author(s):  
Muhammad Waqas ◽  
Cathleen C. Kuo ◽  
Rimal H. Dossani ◽  
Andre Monteiro ◽  
Ammad A. Baig ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cerebral Artery ◽  
Medical Management ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Cochrane Library ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

OBJECTIVE While several studies have compared the feasibility and safety of mechanical thrombectomy (MT) for distal large-vessel occlusion (LVO) strokes in patients, few studies have compared MT with intravenous thrombolysis (IVT) alone. The purpose of this systematic review was to compare the effectiveness and safety between MT and standard medical management with IVT alone for patients with distal LVOs. METHODS PubMed, Google Scholar, Embase, Scopus, Web of Science, Ovid Medline, and Cochrane Library were searched in order to identify studies that directly compared MT with IVT for distal LVOs (anterior cerebral artery A2, middle cerebral artery M3–4, and posterior cerebral artery P2–4). Primary outcomes of interest included a modified Rankin Scale (mRS) score of 0 to 2 at 90 days posttreatment, occurrence of symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days posttreatment. RESULTS Four studies representing a total of 381 patients were included in this meta-analysis. The pooled results indicated that the proportion of patients with an mRS score of 0 to 2 at 90 days (OR 1.16, 95% CI 0.23–5.93; p = 0.861), the occurrence of sICH (OR 2.45, 95% CI 0.75–8.03; p = 0.140), and the mortality rate at 90 days (OR 1.73, 95% CI 0.66–4.55; p = 0.263) did not differ between patients who underwent MT and those who received IVT alone. CONCLUSIONS The meta-analysis did not demonstrate a significant difference between MT and standard medical management with regard to favorable outcome, occurrence of sICH, or 90-day mortality. Prospective clinical trials are needed to further compare the efficacy of MT with IVT alone for distal vessel occlusion.

scholarly journals Endovascular thrombectomy versus medical treatment for large vessel occlusion stroke with mild symptoms: A meta-analysis

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0203066 ◽  
Author(s):  
Yong-Jie Xiong ◽  
Jia-Ming Gong ◽  
Yi-Chi Zhang ◽  
Xin-ling Zhao ◽  
Sha-Bei Xu ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Meta Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Impact of Strategy on Clinical Outcome in Large Vessel Occlusion Stroke Successfully Reperfused: ETIS Registry Results

Stroke ◽  
2021 ◽  
Author(s):  
Marian Douarinou ◽  
Benjamin Gory ◽  
Arturo Consoli ◽  
Bertrand Lapergue ◽  
Maeva Kyheng ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Therapy Group ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Bridging Therapy ◽  
Anterior Circulation ◽  
Vessel Occlusion

Background and Purpose: Approximately half of the patients with acute ischemic stroke due to anterior circulation large vessel occlusion do not achieve functional independence despite successful reperfusion. We aimed to determine influence of reperfusion strategy (bridging therapy, intravenous thrombolysis alone, or mechanical thrombectomy alone) on clinical outcomes in this population. Methods: From ongoing, prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke registry in France, all patients with anterior circulation large vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) following reperfusion therapy were included. Primary end point was favorable outcome, defined as 90-day modified Rankin Scale score ≤2. Patient groups were compared using those treated with bridging therapy as reference. Differences in baseline characteristics were reduced after propensity score-matching, with a maximum absolute standardized difference of 14% for occlusion site. Results: Among 1872 patients included, 970 (51.8%) received bridging therapy, 128 (6.8%) received intravenous thrombolysis alone, and the remaining 774 (41.4%) received MT alone. The rate of favorable outcome was comparable between groups. Excellent outcome (90-day modified Rankin Scale score 0–1) was achieved more frequently in the bridging therapy group compared with the MT alone (odds ratio after propensity score-matching, 0.70 [95% CI, 0.50–0.96]). Regarding safety outcomes, hemorrhagic complications were similar between the groups, but 90-day mortality was significantly higher in the MT alone group compared with the bridging therapy group (odds ratio, 1.60 [95% CI, 1.09–2.37]). Conclusions: This real-world observational study of patients with anterior circulation large vessel occlusion demonstrated a similar rate of favorable outcome following successful reperfusion with different therapeutic strategies. However, our results suggest that bridging therapy compared with MT alone is significantly associated with excellent clinical outcome and lower mortality. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03776877.

'Drip-and-ship' intravenous thrombolysis and outcomes for large vessel occlusion thrombectomy candidates in a hub-and-spoke telestroke model

2021 ◽  
pp. neurintsurg-2021-017819
Author(s):  
Robert W Regenhardt ◽  
Joseph A Rosenthal ◽  
Amine Awad ◽  
Juan Carlos Martinez-Gutierrez ◽  
Neal M Nolan ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Hub And Spoke ◽  
Endovascular Thrombectomy ◽  
Increased Risk ◽  
Intravenous Alteplase ◽  
Model Versus

BackgroundRandomized trials have not demonstrated benefit from intravenous thrombolysis among patients undergoing endovascular thrombectomy (EVT). However, these trials included primarily patients presenting directly to an EVT capable hub center. We sought to study outcomes for EVT candidates who presented to spoke hospitals and were subsequently transferred for EVT consideration, comparing those administered alteplase at spokes (i.e., ‘drip-and-ship’ model) versus those not.MethodsConsecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre-transfer CT angiography defined emergent large vessel occlusion and Alberta Stroke Program CT score ≥6 were identified from a prospectively maintained Telestroke database. Outcomes of interest included adequate reperfusion (Thrombolysis in Cerebral Infarction (TICI) 2b–3), intracerebral hemorrhage (ICH), discharge functional independence (modified Rankin Scale (mRS) ≤2), and 90 day functional independence.ResultsAmong 258 patients, median age was 70 years (IQR 60–81), median National Institutes of Health Stroke Scale (NIHSS) score was 13 (6-19), and 50% were women. Ninety-eight (38%) were treated with alteplase at spokes and 113 (44%) underwent EVT at the hub. Spoke alteplase use independently increased the odds of discharge mRS ≤2 (adjusted OR 2.43, 95% CI 1.08 to 5.46, p=0.03) and 90 day mRS ≤2 (adjusted OR 3.45, 95% CI 1.65 to 7.22, p=0.001), even when controlling for last known well, NIHSS, and EVT; it was not associated with an increased risk of ICH (OR 1.04, 95% CI 0.39 to 2.78, p=0.94), and there was a trend toward association with greater TICI 2b–3 (OR 3.59, 95% CI 0.94 to 13.70, p=0.06).ConclusionsIntravenous alteplase at spoke hospitals may improve discharge and 90 day mRS and should not be withheld from EVT eligible patients who first present at alteplase capable spoke hospitals that do not perform EVT. Additional studies are warranted to confirm and further explore these benefits.

scholarly journals Endovascular Thrombectomy of COVID-19-Related Large Vessel Occlusion: A Systematic Review and Summary of the Literature

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Anas S. Al-Smadi ◽  
John C. Mach ◽  
Srishti Abrol ◽  
Ali Luqman ◽  
Parthasarathi Chamiraju ◽  
...  
Keyword(s):  
Systematic Review ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Abstract WMP112: Safety and Efficacy of Intravenous Thrombolysis and Endovascular Therapy in Children with Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Juliana Pacheco ◽  
Simon Winzer ◽  
Jessica Barlinn ◽  
Heinz Reichmann ◽  
Volker Puetz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Pediatric Stroke ◽  
Stroke Patients ◽  
Safety And Efficacy

Background: Although intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) and endovascular therapy (EVT) are considered standard-of-care treatment of acute ischemic stroke in adults, safety and efficacy of these treatment modalities in children is unknown to date. We reviewed current literature and synthesized data on safety and efficacy of IVT and EVT in children with ischemic stroke. Methods: We performed a systematic review and meta-analysis of all available case series and observational studies that evaluated safety of IVT and EVT in pediatric stroke patients aged less than 18 years. We searched the electronic databases Medline, PubMed, Cochrane Library, Google Scholar for eligible studies. Safety outcomes comprised any intracerebral hemorrhage post-treatment and in-hospital mortality. A random-effects model was used to compute pooled effect estimates and the I 2 statistic was used to assess heterogeneity. Our analysis complied with PRISMA statement. Results: We identified 152 records through database searching, of which only 3 studies with a total of 16,335 pediatric patients with ischemic stroke met our eligibility criteria. Of these studies, two explored safety of sole IVT and one combinatory IVT/EVT. In-hospital mortality rates were similar between pediatric stroke patients treated with either IVT or IVT/EVT and controls (odds ratio=0.85, 95%CI: 0.15-4.87; p=0.857), with moderate evidence of heterogeneity ( I 2 =64%). Risk of intracerebral hemorrhage was substantially increased in children receiving IVT (odds ratio=3.60, 95%CI: 1.66-7.80; p=0.001) compared with controls, with no evidence of heterogeneity ( I 2 =0%). Efficacy of revascularization therapies could not be analyzed due to lack of uniform outcome data in the included studies. Conclusions: Our synthesized data analysis revealed a substantial lack of evidence for acute revascularization treatment of children with ischemic stroke. While an increased risk of intracerebral hemorrhage related to IVT emerged in our analysis, further research is needed to elaborate these findings.

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