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Lee SH, Han JH, Jung I, Jung JM. Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis. Int J Stroke 2020; 15:849-857. [PMID: 32122288 DOI: 10.1177/1747493020909634] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials. AIMS Using multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group. SUMMARY OF REVIEW Twenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome. CONCLUSIONS Safety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients' profiles associated with benefit of treatment.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jung Hoon Han
- Department of Neurology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Ileok Jung
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Jin-Man Jung
- Department of Neurology, 65356Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
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Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, Tu M, Wan Y, Jin P, Xiao G, Xiong Y, Xu G, Liu X. Effect of Retrievable Stent Size on Endovascular Treatment of Acute Ischemic Stroke: A Multicenter Study. AJNR Am J Neuroradiol 2017; 38:1586-1593. [PMID: 28596196 PMCID: PMC7960417 DOI: 10.3174/ajnr.a5232] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/24/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE In clinical practice, stent diameter is one of the variable properties important for endovascular treatment. A consensus guideline for stent retriever size selection has yet to be established. The aim of this study was to investigate the effects of different diameters of Solitaire retrievers on outcomes. MATERIALS AND METHODS Of 628 patients enrolled from the Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry, 256 were treated with the Solitaire 4-mm device and 372, with the 6-mm device. We matched patients treated with the 2 stent sizes using propensity score analysis. The successful outcome was reperfusion as measured by the modified Thrombolysis in Cerebral Infarction score immediately postprocedure and the dichotomized modified Rankin Scale score at 90 days. Symptomatic intracerebral hemorrhage and in-hospital mortality were also recorded. RESULTS After propensity score analysis, group outcomes did not differ. In addition, in patients with atherosclerosis-related occlusion, a higher reperfusion rate (P = .021) was observed in the Solitaire 4 group, as well as a shorter time interval (P = .002) and fewer passes (P = .025). Independent predictors of successful reperfusion in patients with atherosclerotic disease on logistic analysis were the small stent (OR, 3.217; 95% CI, 1.129-9.162; P = .029) and the propensity score acting as a covariate (OR, 52.84; 95% CI, 3.468-805.018; P = .004). CONCLUSIONS We found no evidence of a differential effect of intra-arterial therapy based on the size of Solitaire retrievers. In patients with atherosclerotic disease, favorable reperfusion was associated with deployment of a small stent.
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Affiliation(s)
- D Yang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
| | - Y Hao
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Emergency Medicine (Y.H.), First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - W Zi
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - H Wang
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang, Shandong Province, China
| | - D Zheng
- Department of Neurology (D.Z.), 175th Hospital of the People's Liberation Army, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, Fujian Province, China
| | - H Li
- Department of Neurology (H.L.), 476th Hospital of the People's Liberation Army, Fuzhou, Fujian Province, China
| | - M Tu
- Department of Neurology (M.T.), Hubei Wuchang Hospital, Wuhan, Hubei Province, China
| | - Y Wan
- Department of Neurology (Y.W.), Hubei Zhongshan Hospital, Wuhan, Hubei Province, China
| | - P Jin
- Department of Neurology (P.J.), Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, Anhui Province, China
| | - G Xiao
- Department of Neurology (G.Xiao), Second Affiliated Hospital of Soochow University; Suzhou, Jiangsu Province, China
| | - Y Xiong
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - G Xu
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - X Liu
- From the Department of Neurology (D.Y., H.W., X.L.), Jinling Hospital, Second Military Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (Y.H., G.Xu, X.L.), Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, China
- Department of Neurology (W.Z., Y.X., G.Xu, X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
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