Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited
| Autor: | Jan Gralla, Pascal J. Mosimann, Marcel Arnold, Sandra Bigi, Pasquale Mordasini, Tomas Dobrocky, Sebastian Bellwald, Mirjam Rachel Heldner, Urs Fischer, Johannes Kaesmacher |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Time Factors medicine.medical_treatment MEDLINE Psychological intervention 610 Medicine & health Outcome (game theory) 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Internal medicine medicine Humans Thrombectomy Cerebral infarction business.industry Cerebral Infarction Thrombolysis medicine.disease Psychiatry and Mental health Treatment Outcome Systematic review Cerebrovascular Disease Meta-analysis Reperfusion Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Kaesmacher, Johannes; Dobrocky, Tomas; Heldner, Mirjam Rachel; Bellwald, Sebastian; Mosimann, Pascal John; Mordasini, Pasquale; Bigi, Sandra; Arnold, Marcel; Gralla, Jan; Fischer, Urs (2018). Systematic review and meta-analysis on outcome differences among patients with TICI2b versus TICI3 reperfusions: success revisited. Journal of neurology, neurosurgery and psychiatry, 89(9), pp. 910-917. BMJ Publishing Group 10.1136/jnnp-2017-317602 Journal of Neurology, Neurosurgery, and Psychiatry |
| ISSN: | 1468-330X 0022-3050 |
| Popis: | ObjectiveA reperfusion quality of thrombolysis in cerebral infarction (TICI)≥2b has been set as the therapeutic angiography target for interventions in patients with acute ischaemic stroke. This study addresses whether the distinction between TICI2b and TICI3 reperfusions shows a clinically relevant difference on functional outcome.MethodsA systematic literature review and meta-analysis was carried out and presented in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to test the primary hypothesis that TICI2b and TICI3 reperfusions are associated with different rates of modified Rankin Scale (mRS) ≤2 at day 90. Secondary endpoints included rates of haemorrhagic transformations, mortality and excellent functional outcome (mRS ≤1). Summary estimates of ORs (sOR) with 95% CI were calculated using the inverse variance heterogeneity model accounting for multiple true effect sizes.ResultsFourteen studies on 2379 successfully reperfused patients were included (1131 TICI3, 1248 TICI2b). TICI3 reperfusions were associated with higher rates of functional independence (1.74, 95% CI 1.44 to 2.10) and excellent functional outcomes (2.01, 95% CI 1.60 to 2.53), also after including adjusted estimates. The safety profile of patients with TICI3 was superior, as demonstrated by lower rates of mortality (sOR 0.59, 95% CI 0.37 to 0.92) and symptomatic intracranial haemorrhages (sOR 0.42, 95% CI 0.25 to 0.71).ConclusionTICI3 reperfusions are associated with superior outcome and better safety profiles than TICI2b reperfusions. This effect seems to be independent of time and collaterals. As reperfusion quality is the most important modifiable predictor of patients’ outcome, a more conservative definition of successful therapy and further evaluation of treatment approaches geared towards achieving TICI3 reperfusions are desirable. |
| Databáze: | OpenAIRE |
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