Comment on: “Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis”

Most studies define the technical success of endovascular thrombectomy (EVT) as a Thrombolysis in Cerebral Infarction (TICI) revascularization grade of 2b or higher. However, growing evidence suggests that TICI 3 is the best angiographic predictor of improved functional outcomes. To assess the association between successful TICI revascularization grades and functional independence at 90 days, we performed a systematic review and network meta-analysis of thrombectomy studies that reported TICI scores and functional outcomes, measured by the modified Rankin Scale, using the semi-automated AutoLit software platform. Forty studies with 8691 patients were included in the quantitative synthesis. Across TICI, modified TICI (mTICI), and expanded TICI (eTICI), the highest rate of good functional outcomes was observed in patients with TICI 3 recanalization, followed by those with TICI 2c and TICI 2b recanalization, respectively. Rates of good functional outcomes were similar among patients with either TICI 2c or TICI 3 grades. On further sensitivity analysis of the eTICI scale, the rates of good functional outcomes were equivalent between eTICI 2b50 and eTICI 2b67 (OR 0.81, 95% CI 0.52 to 1.25). We conclude that near complete or complete revascularization (TICI 2c/3) is associated with higher rates of functional outcomes after EVT.

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EXPRESS: Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211047337 ◽

2021 ◽

pp. 174749302110473

Author(s):

Jin Pyeong Jeon ◽

Chih-Hao Chen ◽

Fon-Yih Tsuang ◽

Jianming Liu ◽

Michael D Hill ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Renal Impairment ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Functional Independence ◽

Continuous Variable ◽

Endovascular Thrombectomy ◽

Symptomatic Intracerebral Hemorrhage ◽

The Impact

Background. The impact of renal impairment (RI) on the outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this. Aims. We registered a protocol on September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. RI was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at 3 months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage (sICH). Summary of review. Eleven studies involving 3453 patients were included. For the unadjusted outcomes, RI was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39â0.62) and higher mortality (OR, 2.55; 95% CI, 2.03â3.21). RI was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63â1.00) and sICH (OR, 1.41; 95% CI, 0.95â2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45â0.77), mortality (OR, 2.23, 95% CI, 1.45â3.43), and sICH (OR, 1.34; 95% CI, 0.85â2.10). Conclusions. We presented the first systematic review to demonstrate that RI is associated with fewer functional independence and higher mortality. Future EVT studies should publish complete renal eGFR data to facilitate prognostic studies and permit eGFR to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309

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Effects of aquatic therapy on balance in older adults: a systematic review and meta-analysis

European Geriatric Medicine ◽

10.1007/s41999-021-00577-2 ◽

2021 ◽

Author(s):

Ardalan Shariat ◽

Mahboubeh Ghayour Najafabadi ◽

Shima Ghannadi ◽

Amin Nakhostin-Ansari ◽

Azadeh Hakakzadeh ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Aquatic Therapy

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Ergometer Training in Stroke Rehabilitation: Systematic Review and Meta-analysis

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.09.017 ◽

2020 ◽

Vol 101 (4) ◽

pp. 674-689 ◽

Cited By ~ 2

Author(s):

Jitka Veldema ◽

Petra Jansen

Keyword(s):

Systematic Review ◽

Stroke Rehabilitation ◽

Meta Analysis

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Is Aquatic Therapy Optimally Prescribed for Parkinson’s Disease? A Systematic Review and Meta-Analysis

Journal of Parkinson s Disease ◽

10.3233/jpd-191784 ◽

2020 ◽

Vol 10 (1) ◽

pp. 59-76 ◽

Cited By ~ 3

Author(s):

Louise M. Carroll ◽

Meg E. Morris ◽

William T. O’Connor ◽

Amanda M. Clifford

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Meta Analysis ◽

Aquatic Therapy

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The effect of platelet transfusion on functional independence and mortality after antiplatelet therapy associated spontaneous intracerebral hemorrhage: A systematic review and meta-analysis

Journal of the Neurological Sciences ◽

10.1016/j.jns.2020.117075 ◽

2020 ◽

Vol 417 ◽

pp. 117075

Author(s):

Nicholas A. Morris ◽

Nikhil Patel ◽

Samuel M. Galvagno ◽

Emilie Ludeman ◽

Gary T. Schwartzbauer ◽

...

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Antiplatelet Therapy ◽

Platelet Transfusion ◽

Meta Analysis ◽

Functional Independence ◽

Spontaneous Intracerebral Hemorrhage

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Current evidence for anesthesia management during endovascular stroke therapy: updated systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013916 ◽

2018 ◽

Vol 11 (2) ◽

pp. 107-113 ◽

Cited By ~ 4

Author(s):

Nitin Goyal ◽

Konark Malhotra ◽

Muhammad F Ishfaq ◽

Georgios Tsivgoulis ◽

Christopher Nickele ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Anesthetic Management ◽

Functional Independence ◽

Sensitivity Analyses ◽

Current Evidence ◽

Vessel Occlusion ◽

Random Effects Models ◽

Randomized Studies

IntroductionDebate continues about the optimal anesthetic management for patients undergoing endovascular treatment (ET) of acute ischemic stroke due to emergent large vessel occlusion.ObjectiveTo compare, using current evidence, the clinical outcomes and procedural characteristics among patients undergoing general anesthesia (GA) and local or monitored anesthesia (non-GA).MethodsWe performed a systematic review and meta-analysis of all available studies that involved the use of stent retrievers for ET (stentriever group). Additionally, we included studies that were published in 2015 and later, and compared the clinical outcomes among the studies using stentrievers or no stentrievers (pre-stentriever group). Outcome variables included functional independence (FI; modified Rankin Scale scores of 0–2), symptomatic hemorrhage, mortality, procedure duration, and vascular and respiratory complications. We calculated pooled odds ratios and 95% CIs using random-effects models.ResultsSixteen studies (three randomized controlled clinical trials (RCTs) and 13 non-randomized studies) were identified comprising 5836 patients. Although non-GA was associated with higher odds of 3-month FI (OR=1.57; 95% CI 1.17 to 2.10; P=0.003) and lower odds of 3-month mortality (OR=0.62; 95% CI 0.47 to 0.82; P=0.0006, substantial heterogeneity was noted across included trials. Sensitivity analyses of RCTs showed that non-GA was inversely associated with FI (OR=0.55; 95% CI 0.34 to 0.89; P=0.01; I2=15%), while no association was noted with mortality (OR=1.36; 95% CI 0.79 to 2.34; P=0.27; I2=0%).ConclusionOur updated meta-analysis demonstrates favorable results with non-GA, probably owing to inclusion of non-randomized studies. Recent single-center RCTs indicate that GA is associated with higher odds of FI at 3 months, while other outcomes are similar between the two groups.

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