Mechanical Thrombectomy in Patients with a Large Ischemic Volume at Presentation: Systematic Review and Meta-Analysis
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The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90- day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
Abstract
The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3–6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90- day mortality was 36% (99% CI, 33 to 40; Z-value=–7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3–6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=–5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=–2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=–0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.
참고문헌 (29)
- Turc G, "European Stroke Organisation(ESO) : European Society for minimally invasive neurological therapy(ESMINT)guidelines on mechanical thrombectomy in acute ischemic stroke", J Neurointerv Surg, 11, pp.535~538 (2019)
- Albers GW, "Endovascular thrombectomy in patients with large infarctions : reasons for restraint", Lancet Neurol, 17, pp.836~837 (2018)
- Basile Kerleroux, "Perfusion Imaging to Select Patients with Large Ischemic Core for Mechanical Thrombectomy", 대한뇌졸중학회지, 22(2), pp.225~233 (2020), 대한뇌졸중학회[DOI]
- Cagnazzo F, "Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6 : a meta-analysis", J Neurointerv Surg, 12, pp.350~355 (2020)
- Khoury N, "Diffusion-weighted-imaging infarct volume measurement tools show discrepancies leading to diverging thrombectomy decisions", J Neuroradiol, 48, pp.305~310 (2021)
- Gilgen MD, "Younger stroke patients with large pretreatment diffusion-weighted imaging lesions may benefit from endovascular treatment", Stroke, 46, pp.2510~2516 (2015)
- Sterne JA, "ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions", BMJ, 355, pp.i4919~ (2016)
- Campbell BC, "Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy : a meta-analysis of individual patient-level data", Lancet Neurol, 18, pp.46~55 (2019)
- Berkhemer OA, "A randomized trial of intraarterial treatment for acute ischemic stroke", N Engl J Med, 372, pp.11~20 (2015)
- Bracard S, "Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke(THRACE) : a randomised controlled trial", Lancet Neurol, 15, pp.1138~1147 (2016)
- Sterne JA, "RoB 2: a revised tool for assessing risk of bias in randomised trials", BMJ, 366, pp.4898~ (2019)
- von Elm E, "The strengthening the reporting of observational studies in epidemiology(STROBE)statement : guidelines for reporting observational studies", Ann Intern Med, 147, pp.573~577 (2007)
- Hacke W, "Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators", Lancet, 352, pp.1245~1251 (1998)
- DerSimonian R, "Meta-analysis in clinical trials", Control Clin Trials, 7, pp.177~188 (1986)
- Gautheron V, "Outcome after reperfusion therapies in patients with large baseline diffusion-weighted imaging stroke lesions : a THRACE trial(mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke)subgroup analysis", Stroke, 49, pp.750~753 (2018)
- Rebello LC, "Endovascular treatment for patients with acute stroke who have a large ischemic core and large mismatch imaging profile", JAMA Neurol, 74, pp.34~40 (2017)
- Haussen DC, "Automated CT perfusion ischemic core volume and noncontrast CT ASPECTS(Alberta stroke program early CT score) : correlation and clinical outcome prediction in large vessel stroke", Stroke, 47, pp.2318~2322 (2016)
- Panni P, "Acute stroke with large ischemic core treated by thrombectomy", Stroke, 50, pp.1164~1171 (2019)
- Sarraj A, "Outcomes of endovascular thrombectomy vs medical management alone in patients with large ischemic cores : a secondary analysis of the optimizing patient's selection for endovascular treatment in acute ischemic stroke(SELECT)study", JAMA Neurol, 76, pp.1147~1156 (2019)
- Takeshi Yoshimoto, "Identifying large ischemic core volume ranges in acute stroke that can benefit from mechanical thrombectomy", Journal of NeuroInterventional Surgery, 13(12), pp.1081~1087 (2021), BMJ[DOI]
- Chen Z, "Patients with ischemic core ≥70 ml within 6 h of symptom onset may still benefit from endovascular treatment", Front Neurol, 9, pp.933~ (2018)
- Hassen WB, "Comparison between voxel-based and subtraction methods for measuring diffusion-weighted imaging lesion growth after thrombolysis", Int J Stroke, 11, pp.221~228 (2016)
- Sarraj A, "Triage imaging and outcome measures for large core stroke thrombectomy : a systematic review and meta-analysis", J Neurointerv Surg, 12, pp.1172~1179 (2020)
- Demeestere J, "Evaluation of hyperacute infarct volume using ASPECTS and brain CT perfusion core volume", Neurology, 88, pp.2248~2253 (2017)
- de Margerie-Mellon C, "Can DWI-ASPECTS substitute for lesion volume in acute stroke", Stroke, 44, pp.3565~3567 (2013)
- Goyal M, "Endovascular thrombectomy after largevessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials", Lancet, 387, pp.1723~1731 (2016)
- Nogueira RG, "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct", N Engl J Med, 378, pp.11~21 (2018)
- Albers GW, "Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging", N Engl J Med, 378, pp.708~718 (2018)
- Powers WJ, "2018 Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2018, pp.49, e46~