Journal article
Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis
Journal of neurointerventional surgery, Vol.15(e1), pp.e46-e53
09/2023
DOI: 10.1136/neurintsurg-2022-018896
PMID: 35725306
Abstract
BackgroundIn anterior circulation large vessel occlusion (LVO) in the extended time window, the guidelines recommend advanced imaging (ADVI) to select patients for endovascular therapy (EVT). However, questions remain regarding its availability and applicability in the real world. It is unclear whether an approach to the extended window EVT that does not use ADVI would be equivalent.MethodsIn April 2022, a literature search was performed to identified randomized controlled trials (RCT) and observational studies describing 90-day outcomes. We performed a meta-analysis of the proportion of aggregate using a random effect to estimate rates of functional independence, defined as modified Rankin Scale (mRS) score ≤2 at 90 days, mean mRS, mortality and symptomatic intracranial hemorrhage (sICH) stratified by imaging modality.ResultsFour RCTs and 28 observational studies were included. The pooled proportion of functional independence among patients selected by ADVI was 44% (95% CI 39% to 48%; I2=80%) and 48% (95% CI 41% to 55%; I2=75%) with non-contrast CT/CT angiography (NCCT/CTA) (p=0.36). Mean mRS with ADVI was 2.88 (95% CI 2.36 to 3.41; I2=0.0%) and 2.79 (95% CI 2.31 to 3.27; I2=0.0%) with NCCT (p=0.79). Mortality in patients selected by ADVI was 13% (95% CI 10% to 17%; I2=81%) and 16% (95% CI 12% to 22%; I2=69%) with NCCT (p=0.29). sICH with ADVI was 4% (95% CI 3% to 7%; I2=73%) and 6% with NCCT/CTA (95% CI 4% to 8%; I2=6%, p=0.27).ConclusionsOur study suggests that, in anterior circulation LVO, the rates of functional independence may be similar when patients are selected using ADVI or NCCT for EVT in the extended time window. A simplified triage protocol does not seem to increase mortality or sICH.Protocol registration number(PROSPERO ID: CRD42021236092).
Details
- Title: Subtitle
- Stroke imaging modality for endovascular therapy in the extended window: systematic review and meta-analysis
- Creators
- Joel M Sequeiros - University of Tennessee Health Science CenterAaron Rodriguez-Calienes - Scientific University of the SouthSandra S Chavez-Malpartida - National University of San MarcosCristian Morán-Mariños - Universidad San Ignacio de LoyolaGiancarlo Alvarado-Gamarra - Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru.Marco Malaga - Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru.Alvaro Quincho-Lopez - National University of San MarcosWendy Hernadez-Fernandez - Servicio de Neurologia, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigacion, Hospital Daniel Alcides Carrion, Callao, Peru.Kevin Pacheco-Barrios - Spaulding Rehabilitation HospitalSantiago Ortega-Gutierrez - University of Iowa Hospitals and ClinicsDaniel Hoit - University of Tennessee Health Science CenterAdam S Arthur - University of Tennessee Health Science CenterAndrei V Alexandrov - University of Tennessee Health Science CenterCarlos Alva-Diaz - Scientific University of the SouthLucas Elijovich - University of Tennessee Health Science Center
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.15(e1), pp.e46-e53
- DOI
- 10.1136/neurintsurg-2022-018896
- PMID
- 35725306
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Language
- English
- Electronic publication date
- 06/20/2022
- Date published
- 09/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984303027702771
Metrics
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