Mechanical Thrombectomy for In-Hospital Onset Stroke: A Comparative Systematic Review and Meta-Analysis
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Background and Purpose In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS). Methods We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0. Results In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively. Conclusion While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.
Abstract
Background and Purpose In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS). Methods We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0. Results In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively. Conclusion While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.
참고문헌 (23)
- Lu MY, "Comparison between in-hospital stroke and community-onset stroke treated with endovascular thrombectomy", PLoS One, 14, pp.e0214883~ (2019)
- Suyama K, "Delays in initial workflow cause delayed initiation of mechanical thrombectomy in patients with in-hospital ischemic stroke", Fujita Med J, 8, pp.73~78 (2022)
- Naldi A, "Mechanical thrombectomy for in-hospital stroke : data from the Italian registry of endovascular treatment in acute stroke", J Neurointerv Surg (2023)[DOI]
- Bulwa Z, "Mechanical thrombectomy for patients with in-hospital ischemic stroke : a case-control study", J Stroke Cerebrovasc Dis, 29, pp.104692~ (2020)
- Matsubara N, "Characteristics and treatment results of inhospital acute ischemic stroke due to large vessel occlusion treated by mechanical thrombectomy", J Neuroendovascular Ther, 13, pp.281~287 (2019)
- Qiu K, "Outcomes between inhospital stroke and community-onset stroke after thrombectomy : propensity-score matching analysis", Interv Neuroradiol, 28, pp.296~301 (2022)
- Moher D, "Preferred reporting items for systematic reviews and metaanalyses : the PRISMA statement", PLoS Med, 6, pp.e1000097~ (2009)
- Sterne JA, "ROBINS-I : a tool for assessing risk of bias in non-randomised studies of interventions", BMJ, 355, pp.i4919~ (2016)
- Brown LD, "Interval estimation for a binomial proportion", Statist Sci, 16, pp.101~133 (2001)
- McGrath S, "Meta-analysis of the difference of medians", Biom J, 62, pp.69~98 (2020)
- McGrath S, "Standard error estimation in meta-analysis of studies reporting medians", Stat Methods Med Res, 32, pp.373~388 (2023)
- Galbraith RF, "The radial plot : graphical assessment of spread in ages", Int J Rad Appl Instrum D, 17, pp.207~214 (1990)
- Duval S, "Trim and fill : a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis", Biometrics, 56, pp.455~463 (2000)
- Egger M, "Bias in meta-analysis detected by a simple, graphical test", BMJ, 315, pp.629~634 (1997)
- "METAPREG: Stata module to compute fixed and random effects meta-analysis and meta-regression of proportions. Statistical Software Components S458693" (2019)[URL]
- Viechtbauer W, "Conducting meta-analyses in R with the metafor package", J Stat Softw, 36, pp.1~48 (2010)
- Mönch S, "Worse endovascular mechanical recanalization results for patients with in-hospital onset acute ischemic stroke", J Neurol, 265, pp.2525~2530 (2018)
- Sano T, "In-hospital ischemic stroke treated by mechanical thrombectomy", J Neuroendovasc Ther, 14, pp.133~140 (2020)
- Matsubara N, "Other hospital-onset acute ischemic stroke due to large vessel occlusion treated by mechanical thrombectomy after inter-hospital transfer", Neurol Med Chir(Tokyo), 60, pp.209~216 (2020)
- Cumbler E, "In-hospital ischemic stroke", Neurohospitalist, 5, pp.173~181 (2015)
- Kassardjian CD, "In-patient code stroke : a quality improvement strategy to overcome knowledge-to-action gaps in response time", Stroke, 48, pp.2176~2183 (2017)
- Almutairi S, "Workflow and outcomes of endovascular thrombectomy for in-hospital stroke a systematic review and meta-analysis", J Stroke Cerebrovasc Dis, 30, pp.105937~ (2021)