Christoph J Griessenauer1, Caroline Medin2, Julian Maingard3, Ronil V Chandra4, Wyatt Ng5, Duncan Mark Brooks6, Hamed Asadi3, Monika Killer-Oberpfalzer7, Clemens M Schirmer2, Justin M Moore8, Christopher S Ogilvy9, Ajith J Thomas9, Kevin Phan5. 1. Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. Electronic address: christoph.griessenauer@gmail.com. 2. Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania. 3. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Monash University, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia. 4. Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Monash University, Melbourne, Australia. 5. NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia. 6. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia. 7. Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria. 8. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA. 9. Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
INTRODUCTION: Mechanical thrombectomy has become the standard of care for management of most large vessel occlusion (LVO) strokes. When patients with LVO present with minor stroke symptomatology, no consensus on the role of mechanical thrombectomy exists. METHODS: A systematic review and meta-analysis were performed to identify studies that focused on mechanical thrombectomy, either as a standalone treatment or with intravenous tissue plasminogen activator (IV tPA), in patients with mild strokes with LVO, defined as a baseline National Institutes of Health Stroke Scale score ≤5 at presentation. Data on methodology, quality criteria, and outcome measures were extracted, and outcomes were compared using odds ratio as a summary statistic. RESULTS: Five studies met the selection criteria and were included. When compared with medical therapy without IV tPA, mechanical thrombectomy and medical therapy with IV tPA were associated with improved 90-day modified Rankin Scale (mRS) score. Among medical patients who were not eligible for IV tPA, those who underwent mechanical thrombectomy were more likely to experience good 90-day mRS than those who were not. There was no significant difference in functional outcome between mechanical thrombectomy and medical therapy with IV tPA, and no treatment subgroup was associated with intracranial hemorrhage or death. CONCLUSIONS: In patients with mild strokes due to LVO, mechanical thrombectomy and medical therapy with IV tPA led to better 90-day functional outcome. Mechanical thrombectomy plays an important role in the management of these patients, particularly in those not eligible for IV tPA.
INTRODUCTION: Mechanical thrombectomy has become the standard of care for management of most large vessel occlusion (LVO) strokes. When patients with LVO present with minor stroke symptomatology, no consensus on the role of mechanical thrombectomy exists. METHODS: A systematic review and meta-analysis were performed to identify studies that focused on mechanical thrombectomy, either as a standalone treatment or with intravenous tissue plasminogen activator (IV tPA), in patients with mild strokes with LVO, defined as a baseline National Institutes of Health Stroke Scale score ≤5 at presentation. Data on methodology, quality criteria, and outcome measures were extracted, and outcomes were compared using odds ratio as a summary statistic. RESULTS: Five studies met the selection criteria and were included. When compared with medical therapy without IV tPA, mechanical thrombectomy and medical therapy with IV tPA were associated with improved 90-day modified Rankin Scale (mRS) score. Among medical patients who were not eligible for IV tPA, those who underwent mechanical thrombectomy were more likely to experience good 90-day mRS than those who were not. There was no significant difference in functional outcome between mechanical thrombectomy and medical therapy with IV tPA, and no treatment subgroup was associated with intracranial hemorrhage or death. CONCLUSIONS: In patients with mild strokes due to LVO, mechanical thrombectomy and medical therapy with IV tPA led to better 90-day functional outcome. Mechanical thrombectomy plays an important role in the management of these patients, particularly in those not eligible for IV tPA.
Authors: Negar Asdaghi; Dileep R Yavagal; Kefeng Wang; Nils Mueller-Kronast; Nirav Bhatt; Hannah E Gardener; Carolina M Gutierrez; Erika Marulanda-Londoño; Sebastian Koch; Chuanhui Dong; Sophia A Oluwole; Ricardo Hanel; Brijesh Mehta; Mary Robichaux; Ulises Nobo; Juan C Zevallos; Tatjana Rundek; Ralph L Sacco; Jose G Romano Journal: Stroke Date: 2019-07-15 Impact factor: 7.914
Authors: Ali Z Nomani; Joseph Kamtchum Tatuene; Jeremy L Rempel; Thomas Jeerakathil; Ian R Winship; Khurshid A Khan; Brian H Buck; Ashfaq Shuaib; Glen C Jickling Journal: Neurology Date: 2021-10-04 Impact factor: 9.910