Impact of Periprocedural Hemoglobin Level on the Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke Patients.

Background: Endovascular thrombectomy (EVT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple factors can influence EVT outcomes, including procedural and patient-related variables. This meta-analysis investigated the impact of periprocedural hemoglobin (Hb) levels on EVT outcomes.

Methods: We performed a comprehensive literature search across PubMed, Scopus, Web of Science and Cochrane CENTRAL. We analyzed the mean difference (MD) in Hb levels between good (modified Rankin Scale [mRS] 0-2) and poor (mRS 3-6) prognosis groups. We calculated pooled odds ratios (OR) for Hb levels as a predictor of prognosis and compared mortality and symptomatic intracranial hemorrhage (sICH) across different Hb levels.

Results: The analysis included 921 patients from four studies. Patients in the good prognosis group had significantly higher Hb levels (MD: 0.48 g/dL, 95% CI: [0.2, 0.75], P = 0.0007). Each 1 g/dL increase in Hb was associated with a 22% increase in the odds of achieving a good three-month prognosis (OR: 1.22, 95% CI: [1.13, 1.33], P < 0.00001). Patients with Hb levels ≤13 g/dL in males and ≤12 g/dL in females were 1.69 times more likely to experience mortality (OR: 1.69, 95% CI: [1.1, 2.59], P = 0.02). No significant difference was observed in sICH occurrence between anemic and non-anemic patients.

Conclusion: Higher Hb levels may be associated with improved prognosis, and lower Hb levels might increase mortality risk in AIS-LVO patients undergoing EVT. Further research is needed to validate these findings.