Endovascular therapy versus medical management for ischemic stroke presenting beyond 24â¯hours: Systematic review and meta-analysis.
Clin Neurol Neurosurg
; 244: 108415, 2024 Sep.
Article
em En
| MEDLINE
| ID: mdl-38964022
ABSTRACT
OBJECTIVE:
The ideal management for ischemic stroke presenting in the very late time window, or beyond 24â¯hours from onset, is poorly understood. It is unknown if endovascular therapy (EVT) or best medical management (MM) is associated with superior clinical outcomes.METHODS:
A systematic literature and comparative meta-analysis was completed to evaluate the safety and efficacy of EVT vs. MM for stroke presenting beyond 24â¯hours. Outcome measures included 90â¯day functional independence (mRS 0-2), 90â¯day mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. A random effects model was used for quantitative synthesis.RESULTS:
From the five included studies, a total of 704 patients were included with 461 treated with EVT and 243 treated with MM alone. The proportion of patients achieving functional independence was significantly higher in patients treated with EVT (34.6â¯%) compared to MM alone (15.9â¯%) (OR 4.24; CI 2.61-6.88, P < 0.00001; I2 =0â¯%). While sICH occurred more in EVT patients (6.8â¯%) compared to MM (2.8â¯%), this was not significant (OR 1.96; CI 0.61-6.27, P=0.26; I2 = 67â¯%). Lastly, 90â¯day morality occurred significantly less in the EVT group (24.5â¯%) compared to patients treated with MM (33.1â¯%), and with significantly lower odds (OR 0.51; CI 0.35-0.73, P=0.0003; I2=0â¯%).CONCLUSIONS:
In certain patients presenting beyond 24â¯hours with ischemic stroke, EVT is associated with a significantly higher odds of achieving functional independence and lower odds of mortality compared with MM. While these results do not function as proof, they do encourage further research into extending the window beyond 24â¯hours for EVT. Randomized clinical trials are warranted to validate these findings.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Procedimentos Endovasculares
/
AVC Isquêmico
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article