Outcome after endovascular treatment for acute ischemic stroke by underlying etiology: Tertiary experience and meta-analysis

被引:3
|
作者
Ma, Chunlin [1 ,2 ]
Cao, Wenbo [1 ,3 ]
Huang, Yang [1 ,4 ]
Tian, Qiuyue [5 ]
Chen, Yanfei [1 ,3 ]
Wang, Yabing [1 ,3 ]
Chen, Jian [1 ,3 ]
Gao, Peng [1 ,3 ,6 ]
Dmytriw, Adam A. [7 ,8 ,9 ]
Regenhardt, Robert W. [9 ]
Chen, Fei [10 ]
Ma, Qingfeng [10 ]
Jiao, Liqun [1 ,3 ,6 ]
Yang, Bin [1 ,3 ]
机构
[1] Capital Med Univ, Xuanwu Hosp, Dept Neurosurg, Beijing, Peoples R China
[2] Shanxi Med Univ, Hosp 1, Dept Neurol, Taiyuan, Shanxi, Peoples R China
[3] China Int Neurosci Inst China INI, Beijing, Peoples R China
[4] Yankuang Xinlicheng Gen Hosp, Dept Neurol, Jining, Shandong, Peoples R China
[5] Capital Med Univ, Sch Publ Hlth, Beijing Key Lab Clin Epidemiol, Beijing, Peoples R China
[6] Capital Med Univ, Xuanwu Hosp, Dept Intervent Neuroradiol, Beijing, Peoples R China
[7] Western Univ, London Hlth Sci Ctr, Dept Med Imaging, Neurointervent Program, London, ON, Canada
[8] Western Univ, London Hlth Sci Ctr, Dept Clin Neurol Sci, Neurointervent Program, London, ON, Canada
[9] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA USA
[10] Capital Med Univ, Xuanwu Hosp, Dept Neurol, Beijing, Peoples R China
来源
FRONTIERS IN NEUROLOGY | 2023年 / 14卷
关键词
mechanical thrombectomy; acute ischemic stroke; endovascular treatment; intracranial atherosclerosis; cardioembolism; different etiology; INTRACRANIAL ATHEROSCLEROSIS; MECHANICAL THROMBECTOMY; THERAPY; OCCLUSION; MANAGEMENT; STENOSIS; TRIAL;
D O I
10.3389/fneur.2023.1065484
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
ObjectiveTo investigate the effect of two major etiologies [intracranial atherosclerotic stenosis (ICAS) and cardioembolism (CE])] on outcomes of acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO) after endovascular thrombectomy (EVT). MethodsAnterior circulation AIS patients receiving EVT were retrospectively analyzed. Clinical and laboratory data were collected. Clinical outcomes including favorable outcome (90-day modified Rankin Scale 0-2), mortality, intracranial hemorrhage (ICH) and symptomatic ICH (sICH) were compared. A systematic review and meta-analysis was also performed. ResultsA total of 302 AIS patients were included and divided into the ICAS group (86 patients) and the CE group (216 patients). Patients in the ICAS group were younger (62[18.0] vs. 68[19.0] years, p < 0.001), more likely to have smoking (52.3% vs. 26.9%, p < 0.001) and drinking (52.3% vs. 23.1%, p < 0.001) history, and more frequently required rescue therapy (80.2% vs. 4.6%, p < 0.001) compared to the CE group. However, favorable outcome (aOR 0.722, 95%CI 0.372-1.402, p = 0.336) and mortality (aOR 1.522, 95%CI 0.606-3.831, p = 0.371) were not significantly different between the two groups before and after adjustment. The incidence of sICH and ICH were comparable between the two groups before and after adjustment. Systematic review and meta-analysis consisted of 8 eligible studies (7 previous studies and this current study), incorporating 552 ICAS patients and 1,402 CE patients. Favorable outcome was slightly more likely in the ICAS group compared to the CE group (54.2% vs. 46.3%, OR 1.40, 95%CI 1.00-1.96, I-2 = 53.2%). Moreover, the ICAS group had a lower rate of mortality (14.3% vs. 22.2%, OR 0.63, 95%CI 0.46-0.87, I-2 = 0.0%) and ICH (19.5% vs. 31.9%, OR 0.60, 95%CI 0.42-0.84, I-2 = 0.0%) than the CE group, while the two groups were similar in sICH rate (5.9% vs. 6.7%, OR 0.94, 95%CI 0.55-1.60, I-2 = 6.3%). ConclusionEtiology was not considered as an important factor in functional outcome, despite the differences in baseline characteristics and technical EVT approach. The current study of anterior circulation AIS-LVO patients supports that outcomes for those with ICAS are not significantly different from those with CE.
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页数:10
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