Title :

Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis

Author(s) :

Kerleroux, Basile [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]
Janot, Kevin [Auteur]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Hak, Jean-François [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Kaesmacher, Johannes [Auteur]
Ben Hassen, Wagih [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]
Benzakoun, Joseph [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]
Oppenheim, Catherine [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]
Herbreteau, Denis [Auteur]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Ifergan, Heloise [Auteur]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Bricout, Nicolas [Auteur]
Departement de Neuroradiologie [Lille]
Henon, Hilde [Auteur]
Lille Neurosciences & Cognition (LilNCog) - U 1172
Yoshimoto, Takeshi [Auteur]
Inoue, Manabu [Auteur]
Consoli, Arturo [Auteur]
Hôpital Foch [Suresnes]
Costalat, Vincent [Auteur]
Hôpital Gui de Chauliac [CHU Montpellier]
Naggara, Olivier [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]
Lapergue, Bertrand [Auteur]
Hôpital Foch [Suresnes]
Cagnazzo, Frederico [Auteur]
Hôpital Gui de Chauliac [CHU Montpellier]
Boulouis, Grégoire [Auteur]
Institut de psychiatrie et neurosciences de Paris [IPNP - U1266 Inserm]

Journal title :

Journal of Stroke

Volume number :

23

Pages :

358-366

Publication date :

2021-09-30

ISSN :

2287-6391

Keyword(s) :

Stroke
Ischemic stroke
Thrombectomy

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes ...
Show more >The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3-6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3-6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=-7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3-6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=-5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=-2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=-0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Submission date :

2024-01-16T01:44:42Z
2024-12-05T13:08:52Z