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Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis.
Bala, Fouzi; Beland, Benjamin; Mistry, Eva; Almekhlafi, Mohammed A; Goyal, Mayank; Ganesh, Aravind.
Afiliação
  • Bala F; Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Beland B; Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Mistry E; Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
  • Almekhlafi MA; Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Goyal M; Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
  • Ganesh A; Calgary Stroke Program, Departments of Clinical Neurosciences, Community Health Sciences, and Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
J Neurointerv Surg ; 15(4): 343-349, 2023 Apr.
Article em En | MEDLINE | ID: mdl-35292569
ABSTRACT

BACKGROUND:

Trials of endovascular thrombectomy (EVT) for acute stroke have excluded patients with pre-morbid disability. Observational studies may help inform consideration of EVT in this population. We aimed to assess the effectiveness and safety of EVT in patients with pre-morbid disability.

METHODS:

According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE and Embase for studies describing outcomes in patients with pre-morbid disability (modified Rankin Scale (mRS) 2-5), treated with EVT or medical management (MM). Random-effects meta-analysis was used to pool outcomes including 90-day return to baseline mRS, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.

RESULTS:

We analyzed 14 studies of patients with pre-morbid disability (mRS 2-5, 1373 EVT and 253 MM). The rate of return to baseline mRS was 30.0% (95% CI 25.3% to 34.7%) in patients treated with EVT. Compared with medical therapy, EVT was associated with a higher likelihood of return to baseline mRS (OR 2.37, 95% CI 1.39 to 4.04) and a trend towards lower mortality (OR 0.68, 95% CI 0.46 to 1.02), with similar odds of sICH (OR 1.01, 95% CI 0.49 to 2.08). In studies comparing patients with versus without pre-morbid disability treated with EVT, similar results were found except that pre-morbid disability, when defined more strictly as mRS 3-5, was associated with mortality (OR 3.49, p<0.001).

CONCLUSION:

In eligible patients with pre-morbid disability, observational studies suggest that EVT carries a higher chance of return to baseline mRS compared with patients treated with MM or without pre-morbid disability, although with higher mortality than patients without pre-morbid disability. These findings argue against the routine exclusion of such patients from EVT and merit validation with randomized trials.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares / AVC Isquêmico Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares / AVC Isquêmico Tipo de estudo: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article