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. 2018 May 14:9:301.
doi: 10.3389/fneur.2018.00301. eCollection 2018.

Reperfusion and Clinical Outcomes in Acute Ischemic Stroke: Systematic Review and Meta-Analysis of the Stent-Retriever-Based, Early Window Endovascular Stroke Trials

Nathan W Manning  1   2   3 , Charles D Warne  4 , Philip M Meyers  1   2
Affiliations

Reperfusion and Clinical Outcomes in Acute Ischemic Stroke: Systematic Review and Meta-Analysis of the Stent-Retriever-Based, Early Window Endovascular Stroke Trials

Nathan W Manning et al. Front Neurol. .

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: endovascular; meta-analysis; reperfusion; stent-retriever; stroke; thrombectomy.

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Figures

Figure 1
Figure 1
Forest plots showing odds ratios for association between successful reperfusion rates and patient outcomes.
Figure 2
Figure 2
Predicted probability of modified Rankin Scale score 0–2 by modified thrombolysis in cerebral ischemia grade 2b/3, with dashed line showing 95% CI, and size of markers inversely proportional to each within-trial SD (intention-to-treat analysis).
Figure 3
Figure 3
Predicted probability of modified Rankin Scale score 0–1 by modified thrombolysis in cerebral ischemia grade 2b/3, with dashed line showing 95% CI, and size of markers inversely proportional to each within-trial SD (intention-to-treat analysis).
Figure 4
Figure 4
Predicted probability of symptomatic intracerebral hemorrhage (SICH) by modified thrombolysis in cerebral ischemia grade 2b/3, with dashed line showing 95% CI, and size of markers inversely proportional to each within-trial SD (intention-to-treat analysis).
Figure 5
Figure 5
Predicted probability of death by modified thrombolysis in cerebral ischemia grade 2b/3, with dashed line showing 95% CI, and size of markers inversely proportional to each within-trial SD (intention-to-treat analysis).
See this image and copyright information in PMC

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