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Meta-Analysis
. 2015 Apr;28(2):152-71.
doi: 10.1177/1971400915576678. Epub 2015 Apr 30.

Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: A systematic review and meta-analysis

Reuben Grech  1 , Adrian Mizzi  2 , Richard Pullicino  2 , John Thornton  3 , Jonathan Downer  4
Affiliations
Meta-Analysis

Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: A systematic review and meta-analysis

Reuben Grech et al. Neuroradiol J. 2015 Apr.

Abstract

Background and purpose: Intra-arterial therapy for acute ischaemic stroke has evolved rapidly in the last few years. Stent retrievers have now replaced 'first-generation' devices, which have been the principle devices tested in stroke trials.Our aims were to determine the rates of successful recanalization and functional independence in acute stroke patients treated with stent retrievers. We also sought to assess the safety outcomes of stent retrievers by assessing the rates of mortality and intra-cranial haemorrhage.

Materials and methods: We conducted a systematic review and meta-analysis of studies which utilized stent retrievers as sole treatment or as part of a multi-modal approach in acute ischaemic stroke.

Results: We identified 20 eligible studies: 17 on Solitaire (ev3/Covidien, Irvine, California, USA) (n = 762) and three on Trevo (Stryker, Kalamazoo, Michigan, USA) (n = 210). The mean age of participants was 66.8 (range 62.1-73.0) years and the M:F ratio was 1.1:1. The average stroke severity score (National Institutes of Health Stroke Scale (NIHSS)) at presentation was 17.2. The weighted mean symptom onset to arterial puncture and procedural duration were 265.4 minutes and 54.8 minutes, respectively.Successful recanalization was achieved in 84.5% of patients with a weighted mean of 2.0 stent retriever passes. Independent functional outcome was achieved in 51.2% and the mortality rate was 16.8%.

Conclusion: Stent retrievers have the potential to achieve a high rate of recanalization and functional independence whilst being relatively safe. They should be assessed in well-designed randomized controlled trials to determine their efficacy and assess whether they compare favourably with 'standard treatment' in stroke.

Keywords: Stroke; intra-arterial stroke therapy; mechanical thrombectomy.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Funnel plot (Outcome: Functional independence at 90 days).
Figure 3.
Figure 3.
Pre- and post-procedure TICI and TIMI scores. (a) TICI (Contributing studies – PRE: 2, 3, 9, 11 and 18; POST: 2, 3, 8, 11, 14, 16 and 18) (b) TIMI (Contributing studies – PRE:10 and 17; POST: 7, 10 and 12).
Figure 4.
Figure 4.
Meta-analysis (a) Forest plot of successful recanalization. (b) Forest plot of independent functional outcome.
Figure 5.
Figure 5.
90-day modified Rankin Scores (mRS). (Contributing studies – 1, 9, 12, 14, 15, 16 and 18).
Figure 6.
Figure 6.
Comparison with previous studies. (a) Outcomes. (b) mRS.
Figure 7.
Figure 7.
Comparison with previous studies. (a) Study Characteristics. (b) Safety outcomes.
Figure 8.
Figure 8.
Comparison with SWIFT and TREVO II trials.
See this image and copyright information in PMC

References

    1. Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurg 2011; 76(6 Suppl): S85–S90. - PubMed
    1. Saver JL. Time is brain-quantified. Stroke 2006; 37: 263–266. - PubMed
    1. Jauch EC, Saver JL, Adams HP, Jr, et al. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 870–947. - PubMed
    1. National Institute for Health and Care Excellence 2008. Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). CG68, London: National Institute for Health and Care Excellence, 2008.
    1. Hacke W, Kaste M, Bluhmki E, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359: 1317–1329. - PubMed

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