Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis
| Autor: | Vincent Costalat, Cyril Dargazanli, Gregory Gascou, Federico Cagnazzo, Imad Derraz, Pierre-Henri Lefevre, Carlos Riquelme, Alain Bonafe |
|---|---|
| Přispěvatelé: | Département de Neuroradiologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM) |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_treatment 030204 cardiovascular system & hematology 030218 nuclear medicine & medical imaging Brain Ischemia 0302 clinical medicine Modified Rankin Scale MESH: Thrombectomy Prospective Studies Good outcome Acute ischemic stroke Stroke MESH: Treatment Outcome Randomized Controlled Trials as Topic Thrombectomy MESH: Aged MESH: Middle Aged Radiological and Ultrasound Technology Cerebral infarction Mortality rate Endovascular Procedures MESH: Brain Ischemia General Medicine Thrombolysis Cerebral Infarction Middle Aged Treatment Outcome Meta-analysis Female Intracranial Hemorrhages MESH: Intracranial Hemorrhages medicine.medical_specialty MESH: Endovascular Procedures MESH: Stroke Odds 03 medical and health sciences Internal medicine medicine MESH: Cerebral Infarction [INFO.INFO-IM]Computer Science [cs]/Medical Imaging Humans Radiology Nuclear Medicine and imaging In patient Aged Retrospective Studies MESH: Humans business.industry [SCCO.NEUR]Cognitive science/Neuroscience MESH: Retrospective Studies medicine.disease MESH: Male MESH: Prospective Studies Mechanical thrombectomy MESH: Randomized Controlled Trials as Topic Functional independence Surgery Neurology (clinical) business MESH: Female 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurointerventional Surgery Journal of Neurointerventional Surgery, BMJ Journals, 2020, 12 (4), pp.350-355. ⟨10.1136/neurintsurg-2019-015237⟩ |
| ISSN: | 1759-8486 1759-8478 |
| Popis: | BackgroundIt is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0–2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0–6.ObjectiveTo assess the impact of MT in patients with pretreatment ASPECTS 0–6.MethodsAccording to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0–6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0–2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates.ResultsWe included 17 studies and 1378 patients with ASPECTS 0–6 (1194 MT, 184 medical management). The rate of mRS 0–2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0–2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0–2 was 17.1% in patients with ASPECTS 0–4: 22.1% and 13.9% of patients with ASPECTS 4 and 0–3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b–3) gave higher odds of mRS 0–2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged 70 years (40.3% vs 16.2%).ConclusionsPatients with ASPECTS 0–6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|