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Review
. 2025 Apr 21:15910199251328548.
doi: 10.1177/15910199251328548. Online ahead of print.

Outcomes of patients with heart failure after thrombectomy for ischemic stroke: A systematic review and meta-analysis

Gabriel Marinheiro  1 , Gabriel de Almeida Monteiro  1 , Ivo Queiroz  2 , Lucas M Barbosa  3 , Antonio Mutarelli  4 , Luíza Maria Amaral Tanus  5 , Pedro Henrique Reginato  6 , Ocílio Ribeiro Gonçalves  7 , Marcondes Pimentel Cruz  8 , Agostinho C Pinheiro  9 , Keven Ferreira da Ponte  10 , Gisele Sampaio Silva  11 , João Paulo Mota Telles  12
Affiliations
Review

Outcomes of patients with heart failure after thrombectomy for ischemic stroke: A systematic review and meta-analysis

Gabriel Marinheiro et al. Interv Neuroradiol. .

Abstract

BackgroundMechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke, but its outcomes in patients with heart failure (HF) are uncertain. Some studies suggest worse outcomes in these patients, while others show no significant differences in mortality or functional recovery.MethodsWe systematically searched the MEDLINE, Embase, and Cochrane databases until August 2024. Studies were included if they compared patients with HF to those without. All statistical analyses were carried out using R, version 4.1.1. A subanalysis examined outcomes in HF patients with reduced left ventricular ejection fraction (LVEF).ResultsWe included 3587 patients, of which 1187 (33.1%) were in the HF group. We found a significantly higher mortality (RR 2.01; 95% CI: 1.33-3.03; p < 0.01) and lower risk of favorable neurologic outcome (RR 0.76; 95% CI: 0.67-0.86; p < 0.01) at 90 days on HF group, without a notable difference in the occurrence of symptomatic intracranial hemorrhage (sICH) (RR 1.57; 95% CI: 0.98-2.51; p = 0.06) or recanalization success (RR 1.02; 95% CI: 0.98-1.07; p = 0.28). HF patients with reduced LVEF also showed higher mortality (RR 1.91; 95% CI: 1.05-3.49; p = 0.03) and worse functional outcomes (RR 0.83; 95% CI: 0.72-0.95; p < 0.01) compared to those without HF.ConclusionsHF patients undergoing MT for ischemic stroke may have worse functional outcomes and higher mortality at 90 days compared to non-HF patients despite similar rates of sICH and recanalization success. Our findings suggest that patients with HF may have a worse prognosis compared to those without HF following MT for ischemic stroke.

Keywords: Mechanical thrombectomy; heart failure; ischemic stroke; meta-analysis.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram.
Figure 2.
Figure 2.
Forest plot for mortality in patients with (A) HF and (B) reduced LVEF.
Figure 3.
Figure 3.
Forest plot of favorable neurologic outcome for patients with (A) HF and (B) reduced LVEF.
Figure 4.
Figure 4.
Forest plot of symptomatic intracranial hemorrhage in patients with (A) HF and (B) reduced LVEF.
Figure 5.
Figure 5.
Forest plot of successful recanalization (TICI ≥ 2b) in patients with HF.
See this image and copyright information in PMC

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