Faculty Opinions recommendation of Endovascular therapy for acute ischemic stroke: a systematic review and meta-analysis.

2013 ◽  
Author(s):  
Luciana Mascia ◽  
Anna Teresa Mazzeo
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Meta Analysis

Abstract T MP11: Acute Endovascular Reperfusion Therapy Has Inconsistent Results Across Randomized Clinical Trials -A Systematic Review and Meta-Analysis

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Toshiya Osanai ◽  
Vinary Pasupuleti ◽  
Abhishek Deshpande ◽  
Priyaleela Thota ◽  
Yuani Roman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Primary Outcome ◽  
Randomized Clinical Trials ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Good Outcome

Introduction: Endovascular (intra-arterial, IA) therapy for acute ischemic stroke has become part of acute therapy , but limited randomized clinical trials have had inconsistent results. We sought to evaluate efficacy and safety of endovascular therapy in - randomized clinical trials . Methods: We performed a systematic review of literature for randomized clinical trials of endovascular therapy with thrombolytic or mechanical reperfusion compared with comparator groups without IA therapy. Use of systemic thrombolysis was not excluded. Primary outcome was modified Rankin scale of disability of 0-2 at 90 days and secondary outcomes of mortality at 90 days and symptomatic intracranial hemorrhage was noted. Two groups of independent reviewers searched and identified studies and abstracted data. Random-effects meta-analysis was performed. Subgroups were analyzed by study design characteristics. Results: Systematic search identified 10 studies with 1572 subjects, of which 9 studies reported the primary outcome. IA therapy was associated with good outcome at 90 days (Odds ratio (OR) =1.28; 95% CI, 1.01 to 1.62; p=0.04), but there was significant heterogeneity with p of 0.03. Among 3 trials (n=1136) comparing mechanical thrombectomy with control, mechanical thrombectomy was not superior to control with good outcome (OR=0.98; 95 % CI, 0.85 to 1.14; p=0.83). Patients with IA therapy significantly have good outcome in studies without systematic thrombolysis in the comparator (OR=1.55; 95 % CI, 1.05 to 2.29; p=0.03) and required vessel occlusion for randomization (OR=1.54; 95 % CI, 1.10 to 2.14; p=0.01). Mortality was unchanged with IA therapy (OR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in symptomatic hemorrhage (OR=1.13; 95 % CI, 0.74 to 1.74; p=0.56). Conclusion: IA therapy has a small but significant increase in good outcomes for patients with acute ischemic stroke without increasing mortality and symptomatic hemorrhages.

scholarly journals Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis

2013 ◽  
Vol 88 (10) ◽  
pp. 1056-1065 ◽  
Author(s):  
Balwinder Singh ◽  
Ajay K. Parsaik ◽  
Larry J. Prokop ◽  
Manoj K. Mittal
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Meta Analysis

scholarly journals Clinical Significance of Hyperdense Area after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-10
Author(s):  
Qianmei Jiang ◽  
Jie Hou ◽  
Jian Ge ◽  
Zhichao Huang ◽  
Huaishun Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Significance ◽  
Endovascular Therapy ◽  
Meta Analysis ◽  
Poor Functional Outcome ◽  
Symptomatic Intracerebral Hemorrhage

<b><i>Objective:</i></b> We performed a systematic review and meta-analysis to investigate the clinical significance of hyperdense area after thrombectomy in patients with acute ischemic stroke (AIS). <b><i>Methods:</i></b> We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and other Non-Indexed, Cochrane Library Clinical Controlled Trials and Embase from inception to September 2020 and collected the cohort and case-control studies about the clinical significance of hyperdense area on different types of computed tomography (CT) after thrombectomy in patients with AIS. Outcomes were poor functional outcome (modified Rankin Scale [mRS] Score 3–6 at discharge or 90-day), mortality and subtypes of hemorrhage according to the European Cooperative Acute Stroke Study (ECASS). <b><i>Results:</i></b> 1,999 patients from 16 studies were included in this meta-analysis. Pooled results indicated higher risk of symptomatic intracerebral hemorrhage (odds ratio [OR] = 3.02; 95% confidence interval [CI] 1.84–4.95; <i>p</i> &#x3c; 0.0001, <i>I</i><sup>2</sup> = 0%) in patients with hyperdense area, and the subtype of parenchymal hematoma as well. There was also higher odds of poor functional outcome based on the mRS 3–6 at discharge or 90-day (OR = 1.92; 95% CI 1.35–2.73; <i>p</i> = 0.0003, <i>I</i><sup>2</sup> = 31%) and mortality (OR = 2.06; 95% CI 1.41–3.02; <i>p</i> = 0.0002, <i>I</i><sup>2</sup> = 0%) in patients with hyperdense area after thrombectomy compared with those without hyperdense area. <b><i>Conclusions:</i></b> Our results indicated that the presence of hyperdense area on CT after thrombectomy was associated with high risk of symptomatic intracerebral hemorrhage, poor functional outcome, as well as mortality in patients with AIS. However, further studies were needed to confirm these results. The meta-analysis was conducted in adherence with the PRISMA Statement and was registered at the International Prospective Register of Systematic Reviews (CRD42020164165). To the best of our knowledge, this study is the first meta-analysis investigating the effect of hyperdense area after endovascular therapy in patients with AIS.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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