1. Endovascular therapy for acute ischemic stroke with distal medium vessel occlusion: a systematic review and meta-analysis.
- Author
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De Wei Loh, Enver, Zhi Xian Toh, Keith, Yi Ren Kwok, Gabriel, Yao Hao Teo, Yao Neng Teo, Goh, Claire, Syn, Nicholas L., Fu-Wah Ho, Andrew, Ching-Hui Sia, Sharma, Vijay Kumar, Tan, Benjamin Y. Q., and Yeo, Leonard L. L.
- Subjects
ARTERIAL occlusions ,ONLINE information services ,MEDICAL databases ,META-analysis ,MEDICAL information storage & retrieval systems ,CONFIDENCE intervals ,ISCHEMIC stroke ,SYSTEMATIC reviews ,INTRACRANIAL hemorrhage ,SURGICAL complications ,THROMBOLYTIC therapy ,TREATMENT effectiveness ,FUNCTIONAL assessment ,THROMBECTOMY ,ENDOVASCULAR surgery ,MEDLINE ,ODDS ratio ,PATIENT safety ,EVALUATION - Abstract
Aims Endovascular therapy (EVT) for distal medium vessel occlusions (DMVOs) is a potential frontier of acute ischemic stroke (AIS) treatment, but its efficacy against best medical therapy (BMT) remains unknown. We performed a systematic review and meta-analysis evaluating the efficacy and safety of EVT versus BMT in primary DMVO. Methods We systematically searched PubMed, Cochrane Library and Embase, from inception to August 14, 2022, for studies comparing EVT with BMT in DMVO-AIS. We adopted the Distal Thrombectomy Summit Group's definition of DMVO. Efficacy outcomes were functional independence (90-day modified Rankin Scale (mRS) 0-2) and excellent functional outcomes (90-day mRS 0-1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day mortality. results Fourteen observational and two randomized- controlled studies were included, with 1202 patients receiving EVT and 1267 receiving BMT. After trim-and- fill correction, EVT achieved significantly better odds of functional independence than BMT (adjusted OR 1.61, 95% CI 1.06 to 2.43). There were no significant differences in overall excellent functional outcomes (OR 1.23, 95% CI 0.88 to 1.71), sICH (OR 1.44, 95% CI 0.78 to 2.66), and mortality (OR 1.03, 95% CI 0.73 to 1.45). Stratified by EVT method, mechanical thrombectomy±intra-arterial thrombolysis achieved more excellent functional outcomes than BMT (OR 1.59, 95% CI 1.13 to 2.23). In mild strokes (National Institutes of Health Stroke Scale score <6), EVT caused significantly more sICH (OR 6.30, 95% CI 1.55 to 25.64). Conclusions EVT shows promising efficacy benefit over BMT for primary DMVO-AIS. Further randomized controlled trials are necessary to evaluate the efficacy and safety of EVT in DMVO-AIS. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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