Safety and efficacy of adjunctive intra-arterial antithrombotic therapy during endovascular thrombectomy for acute ischemic stroke: a systematic review and meta-analysis.

Autor:	Marei O; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., Podlasek A; Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK., Soo E; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., Butt W; Queen Elizabeth Hospital Birmingham, Birmingham, UK., Gory B; Department of Diagnostic and Therapeutic Neuroradiology, CHRU de Nancy, Nancy, Lorraine, France., Nguyen TN; Neurology, Boston University School of Medicine, Boston, Massachusetts, USA.; Radiology, Boston Medical Center Department of Radiology, Boston, Massachusetts, USA., Appleton JP; Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Stroke Trials Unit, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK., Richard S; Department of Neurology, Université de Lorraine, Nancy, France., Rice H; Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia., de Villiers L; Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia., Carraro do Nascimento V; Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia., Domitrovic L; Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia., McConachie N; Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Lenthall R; Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Nair S; Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Malik L; Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Panesar J; Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK., Krishnan K; Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.; Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK., Bhogal P; Interventional Neuroradiology, Royal London Hospital, London, UK., Dineen RA; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK., England TJ; Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK.; Stroke Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK., Campbell BCV; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.; Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia., Dhillon PS; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK permesh.dhillon@nottingham.ac.uk.; Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Jan 19. Date of Electronic Publication: 2024 Jan 19.
DOI:	10.1136/jnis-2023-021244
Abstrakt:	Background: Half of patients who achieve successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke experience poor functional outcome. We aim to investigate whether the use of adjunctive intra-arterial antithrombotic therapy (AAT) during EVT is safe and efficacious compared with standard therapy (ST) of EVT with or without prior intravenous thrombolysis. Methods: Electronic databases were searched (PubMed/MEDLINE, Embase, Cochrane Library) from 2010 until October 2023. Data were pooled using a random-effects model and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using ROBINS-I and ROB-2. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes were successful recanalization (modified Thrombolysis In Cerebral Infarction (TICI) 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results: 41 randomized and non-randomized studies met the eligibility criteria. Overall, 15 316 patients were included; 3296 patients were treated with AAT during EVT and 12 020 were treated with ST alone. Compared with ST, patients treated with AAT demonstrated higher odds of functional independence (46.5% AAT vs 42.6% ST; OR 1.22, 95% CI 1.07 to 1.40, P=0.004, I 2 =48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P<0.0001, I 2 =20%). The rates of sICH (OR 1.00, 95% CI 0.82 to 1.22,P=0.97, I2=13%) and successful recanalization (OR 1.09, 95% CI 0.84 to 1.42, P=0.52, I 2 =76%) were not significantly different. Conclusion: The use of AAT during EVT may improve functional outcomes and reduce mortality rates compared with ST alone, without an increased risk of sICH. These findings should be interpreted with caution pending the results from ongoing phase III trials to establish the efficacy and safety of AAT during EVT. Competing Interests: Competing interests: TNN reported research support from Medtronic and SVIN; advisory board with Idorsia. PB reported travel support from Perflow; compensation from Cerenovus, Balt USA, LLC, Vesalio, Phenox Inc, and Brainomix for consultant services. BG has received grants from the French Ministry of Health and is the primary investigator of the TITAN, DIRECT ANGIO, and IA-RESCUE trial, and consulting fees from Air Liquide, MIVI, Medtronic, Boerhinger Ingelheim, Microvention, and Penumbra. JPA is supported, in part, by an NIHR Health and Care Research Scholarship. KK is a recipient of a research fellowship awarded by the Nottingham University Hospitals NHS Trust. There are no other disclosures or competing interests declared by the remaining authors. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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