Xiao Wu1, Mihir Khunte1, Sam Payabvash1, Chengcheng Zhu2, Alexandria Brackett3, Charles C Matouk1, Dheeraj Gandhi4, Pina Sanelli5, Ajay Malhotra6. 1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA. 2. Department of Radiology and Biomedical Imaging, University of Washington, Seattle, Washington, USA. 3. Clinical Information Services, Yale School of Medicine, New Haven, Connecticut, USA. 4. Interventional Neuroradiology Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland, USA. 5. Department of Radiology, Northwell Health Imaging Clinical Effectiveness and Outcomes Research (iCEOR) Program, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, New York, USA. 6. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA. Electronic address: ajay.malhotra@yale.edu.
Abstract
PURPOSE: To determine the outcomes after mechanical thrombectomy (MT) versus medical management in patients with minor stroke symptomatology. METHODS: A meta-analysis was performed for studies reporting outcomes after MT, either as stand-alone therapy or with intravenous thrombolysis in patients with minor stroke and large-vessel occlusion. RESULTS: Fourteen studies with 2134 patients met the selection criteria and were included. Two studies compared immediate thrombectomy versus best medical management (with rescue thrombectomy) and the odds ratios of excellent outcomes, good outcomes, mortality and incidence of symptomatic intracranial hemorrhage (sICH) after immediate thrombectomy versus best medical management were 1.07 (95% confidence interval [CI] 0.93-1.22%), 1.15 (95% CI 1.05-1.25), 0.65 (95% CI 0.30-1.38), and 2.89 (95% CI 0.82-10.13), respectively. Among the 8 studies that compared MT outcomes versus medical management (without thrombectomy), odds ratios of excellent outcomes, good outcomes, mortality, and incidence of sICH after MT versus medical management were 0.98 (95% CI 0.89-1.07), 0.94 (95% CI 0.89-1.00), 1.61 (95% CI 1.08-2.41), and 2.59 (95% CI 1.35-4.96), respectively. Among all 14 studies, pooled proportions of excellent outcomes, good outcomes, mortality, and sICH after thrombectomy were 58.7%, 76.2%, 6.82%, and 3.23%, respectively. CONCLUSIONS: Our study shows significant selection bias and heterogeneity in the literature with differences in baseline characteristics (age, stroke severity, prestroke modified Rankin Scale score, side of infarct, vessel and site of occlusion, use of intravenous thrombolysis, criteria for clinical deterioration, and selection bias for rescue MT and rates of reperfusion), emphasizing the need for a randomized controlled trial.
PURPOSE: To determine the outcomes after mechanical thrombectomy (MT) versus medical management in patients with minor stroke symptomatology. METHODS: A meta-analysis was performed for studies reporting outcomes after MT, either as stand-alone therapy or with intravenous thrombolysis in patients with minor stroke and large-vessel occlusion. RESULTS: Fourteen studies with 2134 patients met the selection criteria and were included. Two studies compared immediate thrombectomy versus best medical management (with rescue thrombectomy) and the odds ratios of excellent outcomes, good outcomes, mortality and incidence of symptomatic intracranial hemorrhage (sICH) after immediate thrombectomy versus best medical management were 1.07 (95% confidence interval [CI] 0.93-1.22%), 1.15 (95% CI 1.05-1.25), 0.65 (95% CI 0.30-1.38), and 2.89 (95% CI 0.82-10.13), respectively. Among the 8 studies that compared MT outcomes versus medical management (without thrombectomy), odds ratios of excellent outcomes, good outcomes, mortality, and incidence of sICH after MT versus medical management were 0.98 (95% CI 0.89-1.07), 0.94 (95% CI 0.89-1.00), 1.61 (95% CI 1.08-2.41), and 2.59 (95% CI 1.35-4.96), respectively. Among all 14 studies, pooled proportions of excellent outcomes, good outcomes, mortality, and sICH after thrombectomy were 58.7%, 76.2%, 6.82%, and 3.23%, respectively. CONCLUSIONS: Our study shows significant selection bias and heterogeneity in the literature with differences in baseline characteristics (age, stroke severity, prestroke modified Rankin Scale score, side of infarct, vessel and site of occlusion, use of intravenous thrombolysis, criteria for clinical deterioration, and selection bias for rescue MT and rates of reperfusion), emphasizing the need for a randomized controlled trial.