Endovascular Thrombectomy VS. Medical Treatment for Mild Stroke Patients: A Systematic Review and Meta-Analysis

Zhao, Yongli; Song, Ying; Guo, Yingchang; Li, Yanru; Zhang, Yi; Ma, Pengju; Li, Guangpeng; Fen-bao, LI

doi:10.1016/j.jstrokecerebrovasdis.2020.105258

Cited by 10 publications

(11 citation statements)

References 33 publications

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“…However, the effect of EVT versus no EVT is not known as administrative databases do not capture information regarding the presence or absence of vessel occlusions 26. Prior meta-analyses generally show neutral results between EVT and BMM in mild stroke due to vessel occlusions in the anterior circulation, but none of them explored proximal ICA or M1 and distal M2 occlusions separately 12 27. As EVT is likely to be beneficial in mild strokes due to proximal ICA or M1 occlusions, but possibly harmful in those due to distal M2 occlusions as noted in this meta-analysis, it is conceivable that the effect of EVT versus BMM would be neutral if patients with proximal or distal occlusions are pooled together.…”

Section: Discussionmentioning

confidence: 99%

Effects of endovascular therapy for mild stroke due to proximal or M2 occlusions: meta-analysis

Lin

Saver

Ovbiagele

et al. 2022

J NeuroIntervent Surg

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ObjectiveTo conduct a meta-analysis to evaluate the effect of endovascular therapy (EVT) in mild acute ischemic stroke (AIS) due to proximal versus distal occlusions.MethodsWe searched PubMed, Embase, the Cochrane Library, and clinicaltrials.gov from January 2000 to September 2021 to identify studies comparing EVT versus best medical management (BMM) in AIS with National Institutes of Health Stroke Scale (NIHSS) scores ≤5 due to proximal internal carotid artery (ICA) or M1 versus distal M2 occlusions. We included studies that reported the number of patients with proximal or distal occlusions separately and reported the number of patients with freedom of disability (modified Rankin Scale (mRS) score 0–1) or functional independence (mRS score 0–2) at 90 days in proximal or M2 occlusions, respectively. OR with 95% CI was used.ResultsWe identified six studies with 653 proximal ICA and M1 occlusion patients and 666 distal M2 occlusion patients. Pooled results showed EVT versus BMM was associated with a higher rate of being disability-free in patients with proximal occlusions (OR 1.58, 95% CI 1.09 to 2.30), but was associated with a lower rate of being disability-free in patients with M2 occlusions (OR 0.70, 95% CI 0.49 to 0.99). Effect of EVT in proximal versus distal occlusions was substantially different (P for interaction=0.002). A similar pattern was seen for functional independence (P for interaction=0.05).ConclusionsFor patients with mild AIS, observational data suggest that EVT may be beneficial for proximal ICA or M1 but not for distal M2 occlusions. Randomized trials are needed to confirm these findings.PROSPERO registration numberCRD42021281034.

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Section: Discussionmentioning

confidence: 99%

Effects of endovascular therapy for mild stroke due to proximal or M2 occlusions: meta-analysis

Lin

Saver

Ovbiagele

et al. 2022

J NeuroIntervent Surg

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“…The results of that showed no significant difference between MT and IVT alone in favorable outcome, occurrence of sICH, or 90-day mortality [30]. Meta-analyses have been conducted to identify whether MT was associated with functional prognosis of AIS patients with an NIHSS score ≤8 and LVO [5, 31], while subjects of the present paper were limited to an NIHSS score ≤5. Furthermore, we have conducted subgroup analysis, sensitivity analysis, and publication bias test, which were not performed in the previous meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis was conducted to compare the functional prognosis of MT and medical management (MM) in AIS patients with an NIHSS score ≤8 and LVO [5]. Although two original studies were reported after that [6, 7], no meta-analysis has been reperformed.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy for Mild Acute Ischemic Stroke with Large-Vessel Occlusion: A Systematic Review and Meta-Analysis

Hou

Wang

et al. 2022

Cerebrovasc Dis

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Background: The functional prognosis of mechanical thrombectomy (MT) for mild acute ischemic stroke (AIS) with large-vessel occlusion (LVO) is controversial. To explore a more precise estimation, a meta-analysis was conducted. Methods: The relevant studies were identified by searching PubMed, Embase, Web of Science, and Cochrane Collaboration Database until October 2021. The pooled analysis, subgroup analysis, sensitivity analysis, and publication bias examination were all conducted. The meta-analysis was performed by using Stata 12.0. Results: Eleven studies were included with a total of 1,929 subjects, including 794 patients receiving MT and 1,135 patients receiving medical management. The pooled analysis showed that MT might be not associated with functional prognosis among mild AIS with LVO (excellent functional prognosis: risk ratio (RR) = 1.07, 95% confidence interval (CI) = 0.94–1.21, p = 0.294; favorable functional prognosis: RR = 1.01, 95% CI = 0.96–1.06, p = 0.823). The statistical stability and reliability were demonstrated by the sensitivity analysis and publication bias outcomes. Conclusion: Our meta-analysis suggests that MT may be not associated with functional prognosis of mild AIS with LVO.

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“…Previous studies report that, compared to standard medical treatment, MT could result in similar clinical outcomes and a higher risk of intracranial hemorrhage (ICH) in LVO patients with minor stroke ( 7 , 8 ). Unlike MT, which has an invasive characteristic concerning arterial wall damage, non-MT treatment, such as intra-arterial thrombolysis (IAT), seems to be an appropriate treatment option for LVO with minor stroke.…”

Section: Introductionmentioning

confidence: 99%

Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

et al. 2022

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BackgroundThe efficacy and safety of mechanical thrombectomy (MT) in acute large vessel occlusion (LVO) patients with minor stroke (NIHSS ≤ 5) remains undetermined. We aimed to compare the efficacy and safety of intra-arterial thrombolysis (IAT) alone vs. MT for LVO patients with minor stroke.MethodsPatients were selected from the Acute Ischemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry, a prospective multicenter registry study, and divided into MT and IAT alone groups. We compared the outcome measures between the two groups, including 90-day functional outcome evaluated by the modified Rankin Scale (mRS), the final recanalization level, intracranial hemorrhage, and mortality within 90-days by logistic regression models with adjustment. Besides the conventional multivariable analysis, we performed a sensitivity analysis by adjusting the propensity score to confirm our results. The propensity score was derived using a logistic regression model.ResultsOf the 120 patients, 63 received IAT alone and 57 received MT as the first-line treatment strategy. As compared to MT group, patients in the IAT alone group were associated with a higher chance of 90-day mRS 0-2 [93.7% vs. 71.9%, odds ratio (OR) = 4.75, 95% confidence interval (CI): 1.20–18.80, P = 0.027], a high chance of 90-day mRS 0-3 (96.8% vs. 86.7%, OR = 11.35, 95% CI: 1.93–66.86, P = 0.007), a shorter median time from puncture to recanalization (PTR) (60 min vs. 100 min, β = −63.70, 95% CI: −81.79– −45.61, P < 0.001), a lower chance of any intracranial hemorrhage (ICH) within 48 h (3.2% vs. 19.3%, OR = 0.15, 95% CI: 0.03–0.79, P = 0.025), and a lower chance of mortablity within 90 days (1.6% vs. 9.2%, OR = 0.05, 95% CI: 0.01–0.57, P = 0.016). Similarly, the sensitivity analysis showed the robustness of the primary analysis.ConclusionsCompared with MT, IAT may improve 90-day clinical outcomes with decreased ICH rate and mortality in LVO patients with minor stroke.

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Endovascular Thrombectomy VS. Medical Treatment for Mild Stroke Patients: A Systematic Review and Meta-Analysis

Cited by 10 publications

References 33 publications

Effects of endovascular therapy for mild stroke due to proximal or M2 occlusions: meta-analysis

Effects of endovascular therapy for mild stroke due to proximal or M2 occlusions: meta-analysis

Mechanical Thrombectomy for Mild Acute Ischemic Stroke with Large-Vessel Occlusion: A Systematic Review and Meta-Analysis

Intra-Arterial Thrombolysis Vs. Mechanical Thrombectomy in Acute Minor Ischemic Stroke Due to Large Vessel Occlusion

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