CTP‐guided reperfusion therapy in acute ischemic stroke: a meta‐analysis

Katyal, Anubhav; Bhaskar, Sonu

doi:10.1111/ane.13374

Cited by 21 publications

(17 citation statements)

References 47 publications

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“…The recruitment of immune cells following an ischemic event may be a contributing factor to this association [ 33 ]. This study used arterial spin labelling (ASL) to characterise PLH, demonstrating how advanced imaging, such as computed tomography perfusion (CTP) [ 34 , 35 ], CT angiography (CTA) [ 36 ] and ASL [ 19 ], have allowed quantitative estimation and characterisation of cerebral perfusion and the delineation of angiographic features including collateral status in AIS patients [ 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.

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Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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“…Stroke is the third leading cause of morbidity and mortality worldwide 12 13‐16 . However, the benefits of reperfusion therapy are not consistent for all patients, as certain factors have been found to predispose patients to worse outcomes after treatment 16,17 .…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, reperfusion therapy, including endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA), has significantly improved clinical outcomes in AIS patients 13‐16 . However, the benefits of reperfusion therapy are not consistent for all patients, as certain factors have been found to predispose patients to worse outcomes after treatment 16,17 . Recognizing such factors is important, as they can inform patient selection by allowing identification of those most likely to respond favourably to treatment 18‐20 …”

Section: Introductionmentioning

confidence: 99%

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Rastogi

Weissert

Bhaskar

2021

Acta Neuro Scandinavica

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Objectives Severity of leukoaraiosis may mediate outcomes after reperfusion therapy in acute ischaemic stroke (AIS) patients. However, the level of the association remains poorly understood. We performed a meta‐analysis to investigate the impact of leukoaraiosis severity on functional outcome, survival, haemorrhagic complications, and procedural success in AIS patients treated with intravenous thrombolysis and/or endovascular thrombectomy. Materials and Methods PubMed, EMBASE and the Cochrane library were searched for studies on leukoaraiosis in AIS receiving reperfusion therapy. A random‐effects meta‐analysis was conducted for post‐reperfusion outcomes in AIS patients with absent‐to‐mild leukoaraiosis and moderate‐to‐severe leukoaraiosis. The strength of association between moderate‐to‐severe leukoaraiosis and poor outcomes was quantified using odds ratios (OR). Results A total of 15 eligible studies involving 6460 patients (1451 with moderate‐to‐severe leukoaraiosis and 5009 with absent‐to‐mild leukoaraiosis) were included in the meta‐analysis. Moderate‐to‐severe leukoaraiosis was significantly associated with poor 90‐day functional outcome (OR 3.16; 95% confidence interval (CI) 2.69–3.72; p < .0001), 90‐day mortality (OR 3.11; 95% CI 2.27–4.26; p < .0001) and increased risk of symptomatic intracerebral haemorrhage (OR 1.69; 95% CI 1.24–2.32; p = .001) after reperfusion therapy. Overall, no significant association of leukoaraiosis severity with haemorrhagic transformation (HT) and angiographic recanalization status were observed. However, subgroup analysis revealed a significant association of WML severity with HT in patients receiving EVT. Conclusion Leukoaraiosis is a useful prognostic biomarker in AIS. Patients with moderate‐to‐severe leukoaraiosis on baseline imaging are likely to have worse clinical and safety outcomes after reperfusion therapy.

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“…2 Moreover, since 2015, in the era of EVT, an increasing attention has been paid to identifying patients or stratifying them based on the clinical profiles or imaging factors, 3,4 who are more likely to benefit from time-critical therapies. [5][6][7][8][9] As such, it is of clinical relevance to fully delineate the role of diabetes in AIS, in the setting of reperfusion therapy. 10 Diabetes is known to be associated with worse functional outcomes and mortality after AIS, 11,12 largely due to its effect on endothelial dysfunction, fibrosis and vascular remodeling.…”

Section: Introductionmentioning

confidence: 99%

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

Bradley¹,

Smokovski²,

Bhaskar³

2022

Adv Clin Exp Med

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CTP‐guided reperfusion therapy in acute ischemic stroke: a meta‐analysis

Cited by 21 publications

References 47 publications

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Leukoaraiosis severity and post‐reperfusion outcomes in acute ischaemic stroke: A meta‐analysis

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

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