Clinical Outcomes and Safety of Mechanical Thrombectomy for Acute Ischaemic Stroke in Patients with Pre-Existing Dependency

Grabli, Florent El; Casolla, Barbara; Ferré, Marc; Kyheng, Maeva; Bala, Fouzi; Lucie, Della Schiava; Cordonnier, Charlotte; Bricout, Nicolas; Hénon, Hilde

doi:10.1016/j.jstrokecerebrovasdis.2021.105848

Cited by 9 publications

(16 citation statements)

References 30 publications

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“…A total of 14 articles from 13 author groups were included. Ten studies compared outcomes between patients with versus without pre-morbid stroke disability treated with EVT 14–24. We found two studies comparing patients with pre-morbid disability treated with EVT to pre-morbidly disabled patients receiving medical management alone 25 26.…”

Section: Resultsmentioning

confidence: 99%

Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis

Bala

Beland

Mistry

et al. 2022

J NeuroIntervent Surg

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BackgroundTrials of endovascular thrombectomy (EVT) for acute stroke have excluded patients with pre-morbid disability. Observational studies may help inform consideration of EVT in this population. We aimed to assess the effectiveness and safety of EVT in patients with pre-morbid disability.MethodsAccording to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and Embase for studies describing outcomes in patients with pre-morbid disability (modified Rankin Scale (mRS) 2–5), treated with EVT or medical management (MM). Random-effects meta-analysis was used to pool outcomes including 90-day return to baseline mRS, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.ResultsWe analyzed 14 studies of patients with pre-morbid disability (mRS 2–5, 1373 EVT and 253 MM). The rate of return to baseline mRS was 30.0% (95% CI 25.3% to 34.7%) in patients treated with EVT. Compared with medical therapy, EVT was associated with a higher likelihood of return to baseline mRS (OR 2.37, 95% CI 1.39 to 4.04) and a trend towards lower mortality (OR 0.68, 95% CI 0.46 to 1.02), with similar odds of sICH (OR 1.01, 95% CI 0.49 to 2.08). In studies comparing patients with versus without pre-morbid disability treated with EVT, similar results were found except that pre-morbid disability, when defined more strictly as mRS 3–5, was associated with mortality (OR 3.49, p<0.001).ConclusionIn eligible patients with pre-morbid disability, observational studies suggest that EVT carries a higher chance of return to baseline mRS compared with patients treated with MM or without pre-morbid disability, although with higher mortality than patients without pre-morbid disability. These findings argue against the routine exclusion of such patients from EVT and merit validation with randomized trials.

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Section: Resultsmentioning

confidence: 99%

Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis

Bala

Beland

Mistry

et al. 2022

J NeuroIntervent Surg

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“…After reading the full-text articles, six studies were excluded due to having included different populations in each group, two studies were excluded for insufficient data regarding the mRS scores of the participants, one study was excluded for not having a comparison group, and one study was excluded for not using the mRS score as the classification score for disability. Finally, six studies published between 2017 and 2021 were included in our meta-analysis ( 14 , 15 , 17 , 18 , 20 , 21 ), involving 4,543 cases with no prior disability and 591 cases with prior functional dependency. Six studies were included for the quantitative analysis of sICH ( 14 , 15 , 17 , 18 , 20 , 21 ), while all but one study ( 15 ) were included in the meta-analysis of clinical outcome and mortality.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, six studies published between 2017 and 2021 were included in our meta-analysis ( 14 , 15 , 17 , 18 , 20 , 21 ), involving 4,543 cases with no prior disability and 591 cases with prior functional dependency. Six studies were included for the quantitative analysis of sICH ( 14 , 15 , 17 , 18 , 20 , 21 ), while all but one study ( 15 ) were included in the meta-analysis of clinical outcome and mortality. The latter study was excluded due to having a different definition for clinical outcome (mRS score of 4 or higher was defined as unfavorable outcome).…”

Section: Resultsmentioning

confidence: 99%

“…Our results are in line with the majority of previous reports. According to Florent et al ( 18 ), patients with PSD tend to have an unfavorable outcome compared to patients with no PSD. However, they report a favorable outcome in one out of every four patients, which is a high proportion of patients that would benefit from EVT in terms of their clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Studies used different criteria for sICH. The criteria suggested by the ECASS III ( 13 – 15 ) and ECASS II ( 16 – 18 ) trials were used by two studies each, while the Heidelberg ( 19 ) criteria were used by one study ( 20 ). One study did not report any criteria ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

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Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

et al. 2022

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IntroductionEndovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical thrombectomy in patients with acute onset ischemic stroke and pre-stroke dependency (PSD) in regard to their clinical outcome and mortality.Materials and MethodsThe MEDLINE, Scopus, and Cochrane Library databases were comprehensively searched with a cut-off date of December 11th, 2021. We performed meta-analysis to investigate the 90-day clinical outcome, the 90-day mortality, and the rate of symptomatic intracerebral hemorrhage (sICH) between the PSD (modified Rankin Scale score ≥ 3) and non-PSD (modified Rankin Scale score = 0–2) groups who underwent EVT for acute onset ischemic stroke.ResultsSix studies were included in the meta-analysis involving 4,543 cases with no PSD and 591 cases with PSD. The non-PSD group showed a statistically significant better clinical outcome at 90 days compared to the PSD group [RR (95% CI) = 1.44 (1.06, 1.85); pz = 0.02]. The non-PSD group demonstrated a statistically significant lower risk of death at 90 days in comparison to the PSD group [RR (95% CI) = 0.45 (0.41, 0.50); pz < 0.01]. Lastly, the rate of sICH was comparable between the two groups [RR (95% CI) = 0.89 (0.64, 1.24); pz = 0.48].DiscussionWe report a higher rate of unfavorable clinical outcome and a higher mortality rate in patients with PSD undergoing EVT compared to those with no previous disability. However, there was a significant proportion of PSD cases who fared well post-procedurally, indicating that PSD patients should not be routinely excluded from mechanical thrombectomy.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021284181, identifier: CRD42021284181.

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Outcomes of endovascular thrombectomy for ischaemic stroke among nonagenarians with and without pre-existing dependency

Chong,

Phillips,

Massarotto

et al. 2024

Journal of Stroke and Cerebrovascular Diseases

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Clinical Outcomes and Safety of Mechanical Thrombectomy for Acute Ischaemic Stroke in Patients with Pre-Existing Dependency

Cited by 9 publications

References 30 publications

Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis

Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis

Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Outcomes of endovascular thrombectomy for ischaemic stroke among nonagenarians with and without pre-existing dependency

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