Reperfusion and Clinical Outcomes in Acute Ischemic Stroke: Systematic Review and Meta-Analysis of the Stent-Retriever-Based, Early Window Endovascular Stroke Trials
AuthorManning, NW; Warne, CD; Meyers, PM
Source TitleFrontiers in Neurology
PublisherFRONTIERS MEDIA SA
University of Melbourne Author/sManning, Nathan
AffiliationFlorey Department of Neuroscience and Mental Health
Document TypeJournal Article
CitationsManning, N. W., Warne, C. D. & Meyers, P. M. (2018). Reperfusion and Clinical Outcomes in Acute Ischemic Stroke: Systematic Review and Meta-Analysis of the Stent-Retriever-Based, Early Window Endovascular Stroke Trials. FRONTIERS IN NEUROLOGY, 9 (MAY), https://doi.org/10.3389/fneur.2018.00301.
Access StatusOpen Access
Objective: To explore the effects of reperfusion grade rates on clinical outcomes in the setting of stent-retriever-based reperfusion therapy for anterior circulation stroke in early time windows. Methods: Systematic searching of Medline and Embase databases was performed to identify stroke trials of stent-retriever-based therapy versus standard care. Mixed effects meta-regression was used to analyze the trial-level association between reperfusion rates and clinical outcomes. Results: A total of five trials met the inclusion criteria (n = 1,287). Rates of successful reperfusion [modified thrombolysis in cerebral ischemia grade 2b/3] demonstrated strong evidence for an association with good functional outcomes [modified Rankin scale score (mRS) 0-2] OR 1.59 (95% CI 1.16, 2.19) p = 0.019 and very strong evidence for an association with excellent functional outcomes (mRS 0-1) OR 2.10 (95% CI 1.46, 3.01) p = 0.007. In addition, there was weak evidence for an association with symptomatic intracranial hemorrhage OR 0.54 (95% CI 0.28, 1.04) p = 0.057 and mortality OR 0.69 (95% CI 0.69, 1.01) p = 0.053. Conclusion: In early, stent-retriever-based acute ischemic stroke treatment, reperfusion appears to be a major predictor of outcomes. Every 10% increase in the rates of successful reperfusion is associated with an 11% increase in the probability of achieving good and 17% increase in the probability of achieving excellent outcomes. Symptomatic intracranial hemorrhage and mortality may be decreased as reperfusion rates are improved.
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