Clinical outcomes of acute ischemic stroke patients treated by direct catheter-based trombectomy depending on their baseline characteristics

Vávrová, Jana; Peisker, Tomas; Vaško, Peter; Rohac, Filip; Kroupa, J; ̌Sťetkářová, Ivana; Widimský, Petr

doi:10.1016/j.crvasa.2017.12.010

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…A total of 811 studies were identified and screened. Of these, 94 studies were assessed for eligibility, and 11 studies 5,9,10,[29][30][31][32][33][34][35][36] were included in the meta-analysis. We documented the reasons for the exclusion of nine eligible studies from the meta-analysis (Figure 1 and Supplement 3).…”

Section: Resultsmentioning

confidence: 99%

Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Jeon

Chen

Liu

et al. 2021

International Journal of Stroke

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Background. The impact of renal impairment (RI) on the outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this. Aims. We registered a protocol on September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. RI was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at 3 months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage (sICH). Summary of review. Eleven studies involving 3453 patients were included. For the unadjusted outcomes, RI was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39â0.62) and higher mortality (OR, 2.55; 95% CI, 2.03â3.21). RI was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63â1.00) and sICH (OR, 1.41; 95% CI, 0.95â2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45â0.77), mortality (OR, 2.23, 95% CI, 1.45â3.43), and sICH (OR, 1.34; 95% CI, 0.85â2.10). Conclusions. We presented the first systematic review to demonstrate that RI is associated with fewer functional independence and higher mortality. Future EVT studies should publish complete renal eGFR data to facilitate prognostic studies and permit eGFR to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309

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Section: Resultsmentioning

confidence: 99%

Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Jeon

Chen

Liu

et al. 2021

International Journal of Stroke

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“…36 These baseline comorbidities in patients with RI are independently associated with worse prognosis, death, and sICH. 37 The Laible 2021 study 14 19 and the Vavrova 2018 study 20 were also excluded from the sensitivity analyses because they did not report a detailed definition of RI. Moreover, the number of patients involved in these two studies was relatively small, which may explain why the results of the Wirtz 2019 study were quite different from those of other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Of the remaining 16 articles eligible for full-text screening, 1 article was excluded for considering the same source of study population as another study, and 4 were excluded for reporting outcomes other than those relevant to our study. Finally, 11 articles, [14][15][16][17][18][19][20][21][22][23][24] including 5053 patients with stroke receiving EVT, were included in the full analysis. The detailed process of article screening is shown in Figure 1.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Association between RI and outcomes 3-month poor functional outcome. In total, 10 studies [15][16][17][18][19][20][21][22][23][24] reported unadjusted data on the association between RI and 3-month poor functional outcomes after EVT. The risk of 3-month poor functional outcome in patients with RI was 2.13 times higher than that in patients without RI; the pooled OR was 2.13 (95% CI, 1.77-2.56; I 2 = 45%).…”

Section: Study Quality and Publication Biasmentioning

confidence: 99%

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Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Wang

Xie

et al. 2022

Ther Adv Neurol Disord

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Background: The association between renal impairment (RI) and stroke outcome after endovascular thrombectomy (EVT) remains unclear, which limits the estimation of patient prognosis by clinicians involved in EVT decision-making. Purpose: This study aimed to investigate the association between RI and acute ischemic stroke (AIS) outcomes in patients treated with EVT. Methods: Studies involving the association between RI at admission and AIS outcomes after EVT were retrieved from the PubMed and Embase databases from their inception to 17 January 2022. A fixed-effects model was used to synthesize the data of the included studies. Sensitivity analysis was performed to identify the source of heterogeneity. Results: Overall, 11 studies, including 5053 patients with stroke receiving EVT, were included in the full analysis. In unadjusted analyses, RI was associated with 3-month poor functional outcome and mortality; the odds ratios (ORs) were 2.13 [10 studies; 95% confidence interval (CI), 1.77–2.56; I2 = 45%] and 2.42 (8 studies; 95% CI, 2.02–2.90; I2 = 58%), respectively. In adjusted analyses, the above associations remained significant; the OR of the 3-month poor functional outcome was 1.49 (5 studies; 95% CI, 1.17–1.90; I2 = 58%), and the OR of the 3-month mortality was 1.84 (6 studies; 95% CI, 1.45–2.33; I2 = 74%). Similar results were obtained in sensitivity analyses. Conclusion: Our results suggest that in patients with AIS who underwent EVT, RI at admission was associated with 3-month poor functional outcome and mortality.

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Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

Zhang

Guo

Sun

et al. 2019

Nicotine &Amp; Tobacco Research

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Introduction The existence of the smoker’s paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT). Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies exploring the association between smoking and good functional outcome (modified Rankin Scale score ≤ 2) following IVT or EVT were searched via the databases of PubMed, Embase, and the Cochrane Library from inception to August 8, 2018. Information on the characteristics of included studies was independently extracted by two investigators. Data were pooled using a random-effects or fixed-effects meta-analysis according to the heterogeneity of included studies. Results Among 20 identified studies, 15 reported functional outcomes following IVT, and five reported functional outcomes following EVT. Unadjusted analyses showed that smoking increased the odds of good functional outcomes with a pooled odds ratio (OR) of 1.48 (95% confidence interval [CI]: 1.36–1.60) after IVT and 2.10 (95% CI: 1.47–3.20) after EVT. Of IVT studies, only eight reported outcomes adjusted for covariates and none of the EVT studies reported adjusted outcomes. After adjustment, the relation between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81–1.59]). Conclusion Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis. Implications The existence of the smoker’s paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional outcome at 3 months in acute ischemic stroke patients who received intravenous thrombolysis (IVT). However, a major limitation of their meta-analysis was that the process of data synthesis was based on unadjusted data. Therefore, we conducted this meta-analysis to investigate the association based on adjusted data and a larger sample size. Our meta-analysis suggested that smoking was not associated with good functional outcome after adjusting for covariates.

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Clinical outcomes of acute ischemic stroke patients treated by direct catheter-based trombectomy depending on their baseline characteristics

Cited by 4 publications

References 33 publications

Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

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