Endovascular Thrombectomy after 24 Hours for Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis of Outcomes

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2024-10-22 DOI:10.1016/j.clineuro.2024.108610

Muhammad Shakir , Hammad Atif Irshad , Bilal Ahmed Lodhi , Zuhaib Ali , Fizza Zubair , Muhammad Umar Mahar , Illiyun Banani , Amna Wajahat , Inamullah Khan , Farhan Siddiq , Adnan I. Qureshi

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引用次数: 0

Abstract

Objective

To evaluate the role of endovascular thrombectomy in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24 hours).

Methods

A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24 hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.

Results

This review included 35 studies with 15,086 patients. The frequency of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24 hours was 4.74% (CI: 3.20%-6.58%), with a risk ratio (RR) of 0.85 (CI: 0.44-1.64) compared to EVT patients treated within 24 hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73% (CI- 27.26%, 44.64%) with an overall pooled risk ratio of 0.85 (CI: 0.34, 2.09). The frequency of the 90-day mortality rate was 22.30% (CI: 16.12%, 29.09%), with an overall pooled risk ratio of 1.80(CI: 0.73, 1.61). The overall frequency of intracerebral hemorrhage (ICH) was 12.23% (CI: 5.47-20.86) following EVT after 24 hours.

Conclusion

Patients treated with EVT after 24 hours have comparable safety and effectiveness to those treated within 24 hours. The outcomes suggest that EVT after 24 hours is a viable treatment option, offering similar benefits to earlier intervention.

查看原文本刊更多论文

大血管闭塞导致急性缺血性卒中患者 24 小时后进行血管内血栓切除术：结果的系统回顾和荟萃分析。

目的评估血管内血栓切除术（EVT）在因大血管闭塞导致的急性缺血性卒中（AIS）晚期（>24 小时）患者中的作用：根据 PRISMA 指南，使用 PubMed、CINAHL、Scopus 和 Google Scholar 数据库（截至 2024 年）进行了一项系统性综述。采用纽卡斯尔-渥太华量表（NOS）进行质量评估。结果分析采用单臂荟萃分析（Sidik-Jonkman模型）和双臂荟萃分析（Mantel-Haenszel模型），比较24小时内和24小时后的EVT，并报告汇总风险比。分析使用 STATA 18.0 版和 Review Manager 5.4.1 版进行，并使用 pResults：本综述纳入了 35 项研究，共 15,086 名患者。与24小时内接受EVT治疗的患者相比，24小时后接受EVT治疗的患者出现症状性脑出血（sICH）的比例为4.78%（95% CI：3.20%-6.58%），风险比（RR）为0.85（95% CI：0.44-1.64）。功能独立（90 天 mRS 0-2）的汇总百分比为 35.73 %（95 % CI- 27.26 %，44.64 %），风险比为 0.85（95 % CI：0.34，2.09）。90天死亡率为22.30%（95% CI：16.12%，29.09%），风险比为1.08（95% CI：0.73，1.61）。24小时后接受EVT治疗的脑出血（ICH）总比例为12.23%（95% CI：5.47-20.86）：结论：24小时后接受EVT治疗的患者与24小时内接受治疗的患者具有相似的安全性和有效性。结果表明，24 小时后进行 EVT 是一种可行的治疗方案，与早期干预具有相似的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.