Reperfusion and Clinical Outcomes in Acute Ischemic Stroke: Systematic Review and Meta-Analysis of the Stent-Retriever-Based, Early Window Endovascular Stroke Trials
Open Access
- 14 May 2018
- journal article
- review article
- Published by Frontiers Media SA in Frontiers in Neurology
- Vol. 9, 301
- https://doi.org/10.3389/fneur.2018.00301
Abstract
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.Keywords
This publication has 23 references indexed in Scilit:
- Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging SelectionThe New England Journal of Medicine, 2015
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trialThe Lancet Neurology, 2014
- Correlation of AOL recanalization, TIMI reperfusion and TICI reperfusion with infarct growth and clinical outcomeJournal of NeuroInterventional Surgery, 2013
- MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort studyThe Lancet Neurology, 2012
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trialThe Lancet Neurology, 2008
- Magnetic resonance imaging profiles predict clinical response to early reperfusion: The diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) studyAnnals of Neurology, 2006
- Improved tests for a random effects meta‐regression with a single covariateStatistics in Medicine, 2003