scholarly journals Should the direct aspiration first pass technique be advocated over the stent-retriever technique for acute ischemic stroke? A systematic review and meta-analysis of 7692 patients

2021 ◽  
Vol 12 ◽  
pp. 597
Author(s):  
Ahmed Negida ◽  
Hazem S. Ghaith ◽  
Mohamed Diaa Gabra ◽  
Mohamed Abdelalem Aziz ◽  
Mohamed Elfil ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rescue Therapy ◽  
Meta Analysis ◽  
Stent Retriever ◽  
Current Evidence ◽  
Cochrane Central Register ◽  
Central Register ◽  
First Pass ◽  
Procedural Complications

Background: The present meta-analysis aimed to synthesize evidence from all published studies with head-to-head data on the outcomes of a direct aspiration first pass technique (ADAPT) and the stent-retriever (SR) in acute ischemic stroke (AIS) patients. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to March 2021 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis random-effects model of DerSimonian-Laird. Results: Thirty studies were included in the meta-analysis with a total of 7868 patients. Compared with the SR, the ADAPT provides slightly higher rates of successful recanalization (RR 1.06, 95% CI [1.02 to 1.10]) and complete recanalization (RR 1.20, 95% CI [1.01 to 1.43]) but with more need for rescue therapy (RR 1.81, 95% CI [1.29 to 2.54]). There were no significant differences between the two techniques in terms of mortality at discharge, mortality at 90 days, change in the National Institutes of Health Stroke Scale score, the favorable outcome (modified Rankin scale (mRS) of 0-2), time to the groin puncture, or frequency of complications as intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), embolus in a new territory (ENT), hemorrhagic infarction, parenchymal hematoma, subarachnoid hemorrhage, or procedural complications (all P > 0.05). Conclusion: Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.

Abstract WP371: Role of Troponin as a Biomarker for Predicting Outcome After Ischemic Stroke: A Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adel A Alhazzani ◽  
Amit Kumar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Biomarker ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Elevated Serum ◽  
Cochrane Central Register ◽  
Central Register ◽  
Predicting Outcome

Background: After acute ischemic stroke, a higher level of troponin has been considered as an important biomarker for predicting mortality. The aim of the study was to quantitatively assess the prognostic significance of the effect of baseline troponin levels on mortality in patients with acute ischemic stroke using a meta-analysis approach. Design: The following electronic databases, PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials , TRIP Database, ClinicalTrials.govwas used for getting the relevant article from literuare. Data were extracted in standardized data collection by two independent investigators. Any disagreements were resolved by consensus. All the statistical analyses were performed in STATA software. Results: 18 studies were included in the present meta-analysis involving a total of 8723 patients. The pooled results suggested that the elevated serum troponin level was associated with in -hospital mortality (RR 2.39, 95% CI 1.37 to 3.41), at the end of last follow up mortality (RR 1.75; 95% CI 1.38 to 2.11) and for overall mortality (RR 1.82; 95% CI 1.47 to 2.17). Sensitivity analysis by removing a single study by turns indicated that there was no obvious impact of any individual study on the pooled risk estimate. No significant publication bias was observed. Conclusion: Our findings indicate that a higher level of troponinmight be an important prognostic biomarker for in hospital and follow up mortality in patients with acute ischemic stroke. The study might have clinical implications by using troponin as a prognostic biomarker for patient stratification and early intervention.

scholarly journals Ciclosporin or Infliximab as Rescue Therapy in Acute Glucorticosteroid-Refractory Ulcerative Colitis: Systematic Review and Network Meta-Analysis

2020 ◽  
Author(s):  
Brigida Barberio ◽  
Christopher J Black ◽  
Edoardo V Savarino ◽  
Alexander C Ford
Keyword(s):  
Ulcerative Colitis ◽  
Rescue Therapy ◽  
Meta Analysis ◽  
Previous Treatment ◽  
Response To Therapy ◽  
Cochrane Central Register ◽  
Serious Adverse Events ◽  
Central Register ◽  
Meta Analyses

Abstract Background Despite randomized controlled trials [RCTs] and trial-based meta-analyses, the optimal rescue therapy for patients with acute glucorticosteroid-refractory ulcerative colitis [UC], to avoid colectomy and improve long-term outcomes, remains unclear. We conducted a network meta-analysis examining this issue. Methods We searched MEDLINE, EMBASE, EMBASE Classic and the Cochrane central register up to June 2020. We included RCTs comparing ciclosporin and infliximab, either with each other or with placebo, in patients with glucorticosteroid-refractory UC. Results We identified seven RCTs containing 534 patients [415 in head-to-head trials of ciclosporin vs infliximab]. Risk of colectomy at ≤ 1 month was reduced significantly with both treatments, compared with placebo (relative risk [RR] of colectomy with infliximab vs placebo = 0.37; 95% confidence interval [CI] 0.21–0.65, RR with ciclosporin vs placebo = 0.40; 95% CI 0.21–0.77). In terms of colectomy between > 1 month and < 1 year, both drugs ranked equally [P-score 0.75]. Neither treatment was more effective than placebo in reducing the risk of colectomy at ≥ 1 year. Both ciclosporin and infliximab were significantly more efficacious than placebo in achieving a response. Neither treatment was more effective than placebo in inducing remission, nor more likely to cause serious adverse events than placebo. Conclusions Both ciclosporin and infliximab were superior to placebo in terms of response to therapy and avoiding colectomy up to 1 year, with no significant differences in efficacy or safety between the two. Ciclosporin remains a valid option to treat refractory UC patients, especially those who do not respond to previous treatment with infliximab, or as a bridge to other biological therapies.

scholarly journals ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i4-i7 ◽  
Author(s):  
Aquilla S Turk ◽  
Don Frei ◽  
David Fiorella ◽  
J Mocco ◽  
Blaise Baxter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
First Pass ◽  
Procedural Complications ◽  
Intracerebral Hemorrhages ◽  
Stent Retrievers ◽  
A New Technique

BackgroundThe development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct aspiration first pass technique with large bore aspiration catheter as the primary method for vessel recanalization.Methods98 prospectively identified acute ischemic stroke patients with 100 occluded large cerebral vessels at six institutions were included in the study. The ADAPT technique was utilized in all patients. Procedural and clinical data were captured for analysis.ResultsThe aspiration component of the ADAPT technique alone was successful in achieving Thrombolysis in Cerebral Infarction (TICI) 2b or 3 revascularization in 78% of cases. The additional use of stent retrievers improved the TICI 2b/3 revascularization rate to 95%. The average time from groin puncture to at least TICI 2b recanalization was 37 min. A 5MAX demonstrated similar success to a 5MAX ACE in achieving TICI 2b/3 revascularization alone (75% vs 82%, p=0.43). Patients presented with an admitting median National Institutes of Health Stroke Scale (NIHSS) score of 17.0 (12.0–21.0) and improved to a median NIHSS score at discharge of 7.3 (1.0–11.0). Ninety day functional outcomes were 40% (modified Rankin Scale (mRS) 0–2) and 20% (mRS 6). There were two procedural complications and no symptomatic intracerebral hemorrhages.DiscussionThe ADAPT technique is a fast, safe, simple, and effective method that has facilitated our approach to acute ischemic stroke thrombectomy by utilizing the latest generation of large bore aspiration catheters to achieve previously unparalleled angiographic outcomes.

scholarly journals TCT-68 Safety and efficacy of stent retriever for the management of acute ischemic stroke. Comprehensive review and meta-analysis

2015 ◽  
Vol 66 (15) ◽  
pp. B30-B31
Author(s):  
Konstantinos Marmagkiolis ◽  
Abdul Hakeem ◽  
Mehmet Cilingiroglu ◽  
Cezar Iliescu ◽  
Despina Tsitlakidou ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Stent Retriever ◽  
Safety And Efficacy ◽  
Comprehensive Review

scholarly journals Selecting the Appropriate First-Line Strategy Based on Hyperdense Vessel Sign in Acute Ischemic Stroke Increases First Pass Recanalization: A Tertiary Center Experience

2022 ◽  
Author(s):  
Uday Bhanu Kovilapu ◽  
Narendra Jain ◽  
Atul Mishra ◽  
Virender Malik
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Rescue Therapy ◽  
Large Vessel Occlusion ◽  
First Line ◽  
Vessel Occlusion ◽  
Tertiary Center ◽  
First Pass ◽  
Noncontrast Computed Tomography

Abstract Background: The data pertaining to selecting an optimal first-line strategy (stent retriever [SR] vs. contact aspiration [CA]) based on noncontrast computed tomography (NCCT) in cases of acute ischemic stroke consequent to large vessel occlusion (LVO) is lacking. Aims: This article studies the influence of hyperdense vessel sign (HVS) in selecting optimal first-line strategy, with intention of increasing first-pass recanalization (FPR). Methods: Upfront approach at our center is SR technique with rescue therapy (CA) adoption consequent to three failed SR attempts to achieve successful recanalization. Data of patients with acute LVO who underwent mechanical thrombectomy from June 2017 to May 2020 was retrospectively analyzed. Patients were classified into HVS (+) and HVS (–) cohort. Rate of successful recanalization (first pass, early, and final) and efficacy of rescue therapy was assessed between the two cohorts. Results: Of 52 patients included, 28 and 24 were assigned to the HVS (+) and HVS (–) cohort, respectively. FPR was observed in 50% of HVS (+) and 20.9% of HVS (–) (p = 0.029). Early recanalization was documented in 64.2% of HVS (+) and 37.5% of HVS (–) (p = 0.054). Rescue therapy need was higher in patients not demonstrating HVS (p = 0.062). Successful recanalization was achieved with rescue therapy in 50% of HVS (–) group. Conclusion: A higher FPR is achievable following individualized first-pass strategy (based on NCCT appearance of clot), instead of a generalized SR first-pass approach. This CT imaging-based strategy is a step closer to achieving primary angiographic goal of FPR.

scholarly journals Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 100 (11) ◽  
pp. 4021-4028 ◽  
Author(s):  
Khalid Benkhadra ◽  
Khaled Mohammed ◽  
Alaa Al Nofal ◽  
Barbara G. Carranza Leon ◽  
Fares Alahdab ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Meta Analysis ◽  
Breast Cancer Mortality ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Risk Of Death ◽  
Central Register ◽  
Reduction Of Mortality

Objectives: The objective was to assess the effect of menopausal hormonal therapy (MHT) on all-cause and cause-specific mortality. Methods: We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus) from inception until August 2013. We included randomized controlled trials (RCTs) of more than 6 months of duration comparing MHT with no treatment. Pairs of independent reviewers selected trials, assessed risk of bias and extracted data. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using the random-effects model. Results: We included 43 RCTs at moderate risk of bias. Meta-analysis showed no effect on mortality (RR 0.99 [95% CI, 0.94–1.05]), regardless of MHT type or history of preexisting heart disease. No association was found between MHT and cardiac death (RR 1.04 [95% CI 0.87–1.23]) or stroke (RR 1.49 [95% CI 0.95–2.31]). Estrogen plus progesterone use was associated with a likely increase in breast cancer mortality (RR 1.96 [95% CI 0.98–3.94]), whereas estrogen use was not. MHT use was not associated with mortality of other types of cancer. In 5 trials, MHT was likely started at a younger age: 2 RCTs with mean age less than 60 and 3 RCTs with MHT started less than 10 years after menopause. Meta-analysis of these 5 RCTs showed a reduction of mortality with MHT (RR 0.70 [95% CI 0.52–0.95]). Conclusion: The current evidence suggests that MHT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. These data may be used to support clinical and policy deliberations about the role of MHT in the care of symptomatic postmenopausal women.

A Direct Aspiration First Pass Technique vs Standard Endovascular Therapy for Acute Stroke: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 19-28 ◽  
Author(s):  
Kevin Phan ◽  
Adam A Dmytriw ◽  
Ian Teng ◽  
Justin M Moore ◽  
Christoph Griessenauer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
First Pass ◽  
Stent Retrievers

Abstract BACKGROUND The direct aspiration first pass technique (ADAPT) is a recent endovascular treatment for ischemic stroke due to large vessel occlusion that has been gaining popularity due to the rapidity of the technique and the potential for cost savings in comparison to standard thrombectomy methods such as stent retrievers. However, few studies have directly compared these 2. OBJECTIVE To compare ADAPT with stent retrievers for thrombectomy via systematic review and meta-analysis. METHODS Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club, and Database of Abstracts of Review of Effectiveness limited to English through September 2016 were systematically searched. Eligible studies included those in which patient cohorts underwent ADAPT for acute stroke. Recanalization efficiency, clinical outcomes, and complication rates of ADAPT were compared with the current standard of endovascular thrombectomy techniques. RESULTS Seventeen studies on ADAPT and 5 randomized controlled trials on endovascular therapy were included. ADAPT achieved higher rates of complete revascularisation (89.4% vs 71.7%, P < .001) but similar clinical outcomes compared to front-line endovascular therapy. Seventy-one point four percent of ADAPT cases were successfully recanalized with aspiration alone, and a trend towards reduced time from groin puncture to recanalization time was noted (44.77 vs 61.46 min, P = .088). CONCLUSION The pooled results are comparable with recent randomized studies that demonstrate the benefit of endovascular therapy over intra-arterial medical therapy. Future direct comparative studies and randomized trials are required to confirm the benefit of the ADAPT strategy compared to standard endovascular therapy for acute ischemic stroke.

Sign in / Sign up

Export Citation Format

Share Document