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Influence of pre-stroke dependency on safety and efficacy of endovascular therapy: A systematic review and meta-analysis.
Zhao, Hengxiao; Bai, Xuesong; Li, Wei; Tian, Qiuyue; Wang, Wenjiao; Guo, Xiaofan; Feng, Yao; Duan, Linyan; Dmytriw, Adam A; Patel, Aman B; Yi, Tingyu; Cao, Wenbo; Min, Xiaoli; Chen, Wenhuo; Jiao, Liqun.
Afiliação
  • Zhao H; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Bai X; China International Neuroscience Institute (China-INI), Beijing, China.
  • Li W; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Tian Q; China International Neuroscience Institute (China-INI), Beijing, China.
  • Wang W; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Guo X; Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China.
  • Feng Y; Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
  • Duan L; Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Dmytriw AA; Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States.
  • Patel AB; Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Yi T; China International Neuroscience Institute (China-INI), Beijing, China.
  • Cao W; Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
  • Min X; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
  • Chen W; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
  • Jiao L; Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Front Neurol ; 13: 956958, 2022.
Article em En | MEDLINE | ID: mdl-36212663
Background and purpose: In the landmark trials studying endovascular thrombectomy (EVT), pre-stroke dependent (PSD) patients were generally excluded. This systematic review and meta-analysis aimed to compare the safety and efficacy of EVT between PSD and pre-stroke independent (PSI) patients. Methods: We searched CENTRAL, Embase, and Ovid MEDLINE up to 11 November 2021 for studies assessing PSD and PSI patients, which were separately defined as pre-stroke mRS score >2 or >1, and ≤2 or ≤1 accordingly. Two authors extracted data and assessed the risk of bias. A meta-analysis was carried out using the random-effects model. Adjusted OR and 95% CI were used to estimate adjusted pool effects. The main outcomes included favorable outcomes, successful recanalization, symptomatic intracranial hemorrhage, and 90-day mortality. Results: A total of 8,004 records met the initial search strategy, and ten studies were included in the final decision. Compared with PSImRS≤2, PSDmRS>2 had a lower favorable outcome (OR 0.51; 95% CI, 0.33-0.79) and higher 90-day mortality (OR 3.32; 95% CI, 2.77-3.98). No significant difference was found in successful recanalization and sICH. After adjustment, only 90-day mortality (aOR 1.99; 95% CI, 1.58-2.49) remained significantly higher in PSDmRS>2. Compared with PSImRS≤1, PSDmRS>1 had lower 90-day mortality (OR, 3.10; 95% CI, 1.84-5.24). No significant difference was found regarding the favorable outcome, successful recanalization, and sICH. After adjustment, no significant difference was found in a favorable outcome, but a higher rate of 90-day mortality (aOR, 2.13; 95% CI, 1.66-2.72) remained in PSDmRS>1. Conclusions: PSD does not innately influence the EVT outcomes regarding sICH and favorable outcomes but may increase the risk of 90-day mortality. Until further evidence is available, it is reasonable to suggest EVT for patients with PSD.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Systematic_reviews Idioma: En Revista: Front Neurol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: China

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Systematic_reviews Idioma: En Revista: Front Neurol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: China