Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis. (10th August 2019)

• Record Type: Journal Article
• Authors: Cagnazzo, Federico; Derraz, Imad; Dargazanli, Cyril; Lefevre, Pierre-Henri; Gascou, Gregory; Riquelme, Carlos; Bonafe, Alain; Costalat, Vincent
• Is Part Of: Journal of neurointerventional surgery. Volume 12:Number 4(2020)
• Page Start: 350
• Page End: 355
• Publication Date: 2019-08-10
• Subjects: stroke -- thrombectomy -- thrombolysis; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2019-015237
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: It is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0–2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0–6. Objective: To assess the impact of MT in patients with pretreatment ASPECTS 0–6. Methods: According to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0–6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0–2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates. Results: We included 17 studies and 1378 patients with ASPECTS 0–6 (1194 MT, 184 medical management). The rate of mRS 0–2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0–2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0–2 was 17.1% in patients with ASPECTS 0–4: 22.1% and 13.9% of patients with ASPECTS 4 and 0–3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b–3) gave higher odds of mRS 0–2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged <70 years had higher rates of mRS 0–2 than those aged >70 years (40.3% vs 16.2%). Conclusions: Patients with ASPECTS 0–6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome.