Influence of pre-stroke dependency on safety and efficacy of endovascular therapy: A systematic review and meta-analysis

Hengxiao Zhao; Xuesong Bai; Wei Li; Qiuyue Tian; Wenjiao Wang; Xiaofan Guo; Yao Feng; Linyan Duan; Adam A Dmytriw; Aman B Patel; Tingyu Yi; Wenbo Cao; Xiaoli Min; Wenhuo Chen; Liqun Jiao

doi:10.3389/fneur.2022.956958

Influence of pre-stroke dependency on safety and efficacy of endovascular therapy: A systematic review and meta-analysis

Front Neurol. 2022 Sep 21:13:956958. doi: 10.3389/fneur.2022.956958. eCollection 2022.

Authors

Hengxiao Zhao^{1

2}, Xuesong Bai^{1

2}, Wei Li^{1

3}, Qiuyue Tian⁴, Wenjiao Wang⁵, Xiaofan Guo⁶, Yao Feng^{1

2}, Linyan Duan^{7

8}, Adam A Dmytriw⁹, Aman B Patel⁹, Tingyu Yi¹⁰, Wenbo Cao^{1

2}, Xiaoli Min¹¹, Wenhuo Chen¹⁰, Liqun Jiao^{1

2

12}

Affiliations

¹ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
² China International Neuroscience Institute (China-INI), Beijing, China.
³ Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, China.
⁴ Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.
⁵ Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁶ Department of Neurology, Loma Linda University Health, Loma Linda, CA, United States.
⁷ Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁸ Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China.
⁹ Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
¹⁰ Department of Neurology, Zhangzhou Affiliated Hospital, Fujian Medical University, Fuzhou, China.
¹¹ Department of Cerebrovascular Diseases, The Second Affiliated Hospital, Kunming Medical University, Kunming, China.
¹² Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China.

Abstract

Background and purpose: In the landmark trials studying endovascular thrombectomy (EVT), pre-stroke dependent (PSD) patients were generally excluded. This systematic review and meta-analysis aimed to compare the safety and efficacy of EVT between PSD and pre-stroke independent (PSI) patients.

Methods: We searched CENTRAL, Embase, and Ovid MEDLINE up to 11 November 2021 for studies assessing PSD and PSI patients, which were separately defined as pre-stroke mRS score >2 or >1, and ≤2 or ≤1 accordingly. Two authors extracted data and assessed the risk of bias. A meta-analysis was carried out using the random-effects model. Adjusted OR and 95% CI were used to estimate adjusted pool effects. The main outcomes included favorable outcomes, successful recanalization, symptomatic intracranial hemorrhage, and 90-day mortality.

Results: A total of 8,004 records met the initial search strategy, and ten studies were included in the final decision. Compared with PSI_mRS≤2, PSD_mRS>2 had a lower favorable outcome (OR 0.51; 95% CI, 0.33-0.79) and higher 90-day mortality (OR 3.32; 95% CI, 2.77-3.98). No significant difference was found in successful recanalization and sICH. After adjustment, only 90-day mortality (aOR 1.99; 95% CI, 1.58-2.49) remained significantly higher in PSD_mRS>2. Compared with PSI_mRS≤1, PSD_mRS>1 had lower 90-day mortality (OR, 3.10; 95% CI, 1.84-5.24). No significant difference was found regarding the favorable outcome, successful recanalization, and sICH. After adjustment, no significant difference was found in a favorable outcome, but a higher rate of 90-day mortality (aOR, 2.13; 95% CI, 1.66-2.72) remained in PSD_mRS>1.

Conclusions: PSD does not innately influence the EVT outcomes regarding sICH and favorable outcomes but may increase the risk of 90-day mortality. Until further evidence is available, it is reasonable to suggest EVT for patients with PSD.

Keywords: endovascular therapy (EVT); ischemic stroke; meta-analysis; patient selection; systematic review; treatment outcome.

Publication types

Systematic Review