Endovascular Thrombectomy for Low ASPECTS Large Vessel Occlusion Ischemic Stroke: A Systematic Review and Meta-Analysis

被引：21

作者：

Diestro, Jose Danilo B. ^{[1
,2
]}

Dmytriw, Adam A. ^{[2
]}

Broocks, Gabriel ^{[3
]}

Chen, Karen ^{[4
]}

Hirsch, Joshua A. ^{[5
]}

Kemmling, Andre ^{[3
]}

Phan, Kevin ^{[6
,7
]}

Bharatha, Aditya ^{[1
,2
,8
]}

机构：

[1] St Michaels Hosp, Div Diagnost & Therapeut Neuroradiol, Dept Med Imaging, Toronto, ON, Canada

[2] Univ Toronto, Dept Med Imaging, Toronto, ON, Canada

[3] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA 02115 USA

[5] Harvard Med Sch, Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02115 USA

[6] NeuroSpine Surg Res Grp NSURG, Sydney, NSW, Australia

[7] Prince Wales Private Hosp, Sydney, NSW, Australia

[8] Univ Toronto, Dept Surg, Div Neurosurg, St Michaels Hosp, Toronto, ON, Canada

来源：

CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES | 2020年 / 47卷 / 05期

关键词：

ASPECTS; Stroke; Thrombectomy; Meta-analysis; EARLY CT SCORE; HEALTH-CARE PROFESSIONALS; COMPUTED-TOMOGRAPHY SCORE; ALBERTA STROKE; MECHANICAL THROMBECTOMY; DWI-ASPECTS; HEMORRHAGIC TRANSFORMATION; INTRAVENOUS ALTEPLASE; THROMBOLYSIS; REPERFUSION;

D O I：

10.1017/cjn.2020.71

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: The current American Heart Association guidelines for acute ischemic stroke reserve Grade 1A recommendation for the use of endovascular thrombectomy (EVT) for patients with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of >= 6. Objective: We aim to determine the safety and efficacy of EVT for large vessel occlusion ischemic stroke patients with low ASPECTS (5 or less). Methods: Medline, Cochrane Central Register of Controlled Trials, andClinicalTrials.govwere searched for studies appraising the outcomes of EVT for low ASPECTS ischemic stroke. A meta-analysis of proportions compared the clinical outcomes of patients undergoing EVT and those receiving best medical therapy only. Results: Nine studies (1,196 patients) were included. There was a trend (p = 0.11) toward a higher rate of symptomatic intracranial hemorrhage (sICH) in the EVT group (9.2%; 95% CI 6.1-13.6; I(2)53.37%) compared to the medical group (5.5%; 95% CI 3.7-8.1; I(2)0%). There was no difference (p = 0.41) in the pooled 90-day mortality of EVT patients (30.7%; 95% CI 21.7-41.5; I(2)84.23%) and medical patients (36.6%; 95% CI 26.4-48.1; I(2)76.2%). EVT patients had better (p = 0.001) 90-day outcomes, with 27.7% (95% CI 21.8-34.5; I(2)62.08%) of patients attaining a modified Rankin Scale of 0-2 compared to only 3.7% (95% CI 2.3-5.9; I(2)87.21%) in the medical group. Conclusions: This meta-analysis demonstrates a trend in higher sICH among low ASPECTS patients undergoing EVT. Despite this, a significant proportion of this subset of patients still achieved good functional outcomes at 90 days. Randomized trials are necessary to substantiate this result as significant bias is inherent in the observational studies included in this review.

引用

页码：612 / 619

页数：8

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