Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials
Abstract Background Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial. Methods In this retrospective study, a total of 1...
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doaj-de9058434e684ba392cef0345c9eea8f2020-11-25T03:00:30ZengBMCBMC Neurology1471-23772019-07-011911710.1186/s12883-019-1372-9Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trialsXian-Jin Shang0Zhong-Hua Shi1Cai-Feng He2Shuai Zhang3Yong-Jie Bai4Yong-Tao Guo5Bo Sun6Shun Li7Huai-Ming Wang8Zhi-Ming Zhou9Wen-Jie Zi10Xin-Feng Liu11Department of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurosurgery, The 101st Hospital of the People’s Liberation ArmyDepartment of Dermatology, Yijishan Hospital of Wannan Medical CollegeDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Medical School of Nanjing UniversityDepartment of Neurology, Yijishan Hospital of Wannan Medical CollegeDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityDepartment of Neurology, Jinling Hospital, Jinling Clinical College of Nanjing Medical UniversityAbstract Background Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial. Methods In this retrospective study, a total of 177 Chinese patients presenting with MIS (NIHSS ≤8) and LVO between January 2014 and September 2017 from seven comprehensive stroke centers were identified. Odds of good outcome with endovascular thrombectomy versus medical treatment were obtained by logistic regression analysis and propensity-score matching method, and a meta-analysis pooled results from six studies (n = 733). Results Good outcome (mRS: 0–1) was 58.2% (46/79) in the thrombectomy and 46.9% (46/98) in the medical group, which showed no statistical significance before adjustment (P = 0.13; OR = 1.57, 95% CI: 0.86 to 2.86). The adjusted ORs of thrombectomy versus medical group were 3.23 (95% CI, 1.35 to 7.73; P = 0.008) by multivariable logistic analysis, 2.78 (1.12 to 6.89; P = 0.02) by propensity score matching analysis, and 3.20 (1.22 to 8.37; P = 0.01) by propensity score matching analysis with additional adjustments, respectively. Thrombectomy treatment did not result in excessive mortality or symptomatic intracranial hemorrhage after adjustments. The meta-analysis did not confirm the associations between good outcome and endovascular treatment. Conclusions The current study indicates that endovascular thrombectomy is associated with good functional outcome in MIS patients with LVO, and without additional risk of symptomatic intracranial hemorrhage and mortality. Although the meta-analysis failed to demonstrate its superiority compared to medical treatment, randomized clinical trials are needed.http://link.springer.com/article/10.1186/s12883-019-1372-9ThrombectomyStrokeEndovascularOutcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xian-Jin Shang Zhong-Hua Shi Cai-Feng He Shuai Zhang Yong-Jie Bai Yong-Tao Guo Bo Sun Shun Li Huai-Ming Wang Zhi-Ming Zhou Wen-Jie Zi Xin-Feng Liu |
spellingShingle |
Xian-Jin Shang Zhong-Hua Shi Cai-Feng He Shuai Zhang Yong-Jie Bai Yong-Tao Guo Bo Sun Shun Li Huai-Ming Wang Zhi-Ming Zhou Wen-Jie Zi Xin-Feng Liu Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials BMC Neurology Thrombectomy Stroke Endovascular Outcome |
author_facet |
Xian-Jin Shang Zhong-Hua Shi Cai-Feng He Shuai Zhang Yong-Jie Bai Yong-Tao Guo Bo Sun Shun Li Huai-Ming Wang Zhi-Ming Zhou Wen-Jie Zi Xin-Feng Liu |
author_sort |
Xian-Jin Shang |
title |
Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
title_short |
Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
title_full |
Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
title_fullStr |
Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
title_full_unstemmed |
Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
title_sort |
efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials |
publisher |
BMC |
series |
BMC Neurology |
issn |
1471-2377 |
publishDate |
2019-07-01 |
description |
Abstract Background Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial. Methods In this retrospective study, a total of 177 Chinese patients presenting with MIS (NIHSS ≤8) and LVO between January 2014 and September 2017 from seven comprehensive stroke centers were identified. Odds of good outcome with endovascular thrombectomy versus medical treatment were obtained by logistic regression analysis and propensity-score matching method, and a meta-analysis pooled results from six studies (n = 733). Results Good outcome (mRS: 0–1) was 58.2% (46/79) in the thrombectomy and 46.9% (46/98) in the medical group, which showed no statistical significance before adjustment (P = 0.13; OR = 1.57, 95% CI: 0.86 to 2.86). The adjusted ORs of thrombectomy versus medical group were 3.23 (95% CI, 1.35 to 7.73; P = 0.008) by multivariable logistic analysis, 2.78 (1.12 to 6.89; P = 0.02) by propensity score matching analysis, and 3.20 (1.22 to 8.37; P = 0.01) by propensity score matching analysis with additional adjustments, respectively. Thrombectomy treatment did not result in excessive mortality or symptomatic intracranial hemorrhage after adjustments. The meta-analysis did not confirm the associations between good outcome and endovascular treatment. Conclusions The current study indicates that endovascular thrombectomy is associated with good functional outcome in MIS patients with LVO, and without additional risk of symptomatic intracranial hemorrhage and mortality. Although the meta-analysis failed to demonstrate its superiority compared to medical treatment, randomized clinical trials are needed. |
topic |
Thrombectomy Stroke Endovascular Outcome |
url |
http://link.springer.com/article/10.1186/s12883-019-1372-9 |
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