Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ? 6: A meta-analysis - 28/02/20
, Imad Derraz, MD, Cyril Dargazanli, MD, Pierre-Henri Lefevre, MD, Gregory Gascou, MD, Carlos Riquelme, MD, Alain Bonafe, MD, Vincent Costalat, MDResumen |
Background |
Whether mechanical thrombectomy (MT) increases the probability of good outcome (mRS0-2) in ASPECTS 0–6 patients is debated.
Objective |
To assess the impact of the MT in pre-treatment ASPECTS 0–6 patients.
Methods |
According to PRISMA guidelines, we performed a systematic search of three databases, including series of ASPECTS 0–6 patients treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS0-2 at 3-months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates.
Results |
We included 17 studies and 1378 ASPECTS 0–6 patients (MT=1194, medical management=184). The rate of mRS0-2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS0-2 (OR=4.76, P=0.01). ASPECTS 6 and 5 patients had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS0-2 was 17.1% among ASPECTS 0–4 patients: 22.1% and 13.9% of ASPECTS 4 and 0–3 patients were independent, respectively. Successful recanalization (TICI2b-3) gave higher odds of mRS0-2 compared to unsuccessful reperfusion (OR=5.2, P=0.001). The MT group tended to have lower odds of sICH, compared to the controls (OR=0.48, P=0.06). Patients aged<70 vs>70 years had higher rates of mRS0-2 (40.3% vs 16.2%).
Conclusions |
ASPECTS 0–6 patients may benefit from MT. Successful reperfusion increases the probability of 3-months functional independence, without increasing the risk of sICH. ASPECTS 5 and 6 patients present comparable outcomes. MT can still allow approximately 1 in 4 ASPECTS 4 patients to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome.
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Vol 47 - N° 2
P. 102 - mars 2020 Regresar al número
Artículo precedente
- Treatment of unruptured distal anterior circulation aneurysms with flow diverter stents: A meta-analysis
- Federico Cagnazzo, Paolo Perrini, Cyril Dargazanli, Pierre-Henri Lefevre, Gregory Gascou, Riccardo Morganti, Davide di Carlo, Imad Derraz, Carlos Riquelme, Alain Bonafe, Vincent Costalat
- Comparison between prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms. A meta-analysis
- Federico Cagnazzo, Paolo Perrini, Pierre-Henri Lefevre, Gregory Gascou, Cyril Dargazanli, Carlos Riquelme, Imad Derraz, Davide di Carlo, Alain Bonafe, Vincent Costalat
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