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Lee KS, Siow I, Zhang JJ, Syn NL, Gillespie CS, Yuen LZ, Anil G, Yang C, Chan BP, Sharma VK, Teoh HL, Mingxue J, Teo KSH, Myint MZ, Bhogal P, Meyer L, Schob S, Sia CH, Mpotsaris A, Maus V, Andersson T, Arnberg F, Gontu VK, Lee TH, Tan BYQ, Yeo LL. Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients. J Neurointerv Surg 2023; 15:1039-1045. [PMID: 36175014 DOI: 10.1136/jnis-2022-019510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO). OBJECTIVE To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature. METHODS Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH). RESULTS Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563). CONCLUSIONS In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
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Affiliation(s)
- Keng Siang Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Isabel Siow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Jy Zhang
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Linus Zh Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gopinathan Anil
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Divison of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Divison of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Bernard Pl Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vijay Kumar Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock-Luen Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jing Mingxue
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Kevin Soon Hwee Teo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - May Zin Myint
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle/Saale, Halle, Germany
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Tommy Andersson
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Vamsi Krishna Gontu
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Tsong-Hai Lee
- Department of Neruology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Benjamin Y Q Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Ll Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
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Teo YN, Sia CH, Tan BYQ, Mingxue J, Chan B, Sharma VK, Makmur A, Gopinathan A, Yang C, Loh S, Ng S, Ong SJ, Teoh HL, Rathakrishnan R, Andersson T, Arnberg F, Gontu VK, Lee TH, Maus V, Meyer L, Bhogal P, Spooner O, Li TY, Soh RY, Yeo LL. Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:127-132. [PMID: 35101960 DOI: 10.1136/neurintsurg-2021-018406] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/31/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject. METHODS A systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2c-3) and first pass effect (FPE, defined as TICI 2c-3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0-2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I2 test. RESULTS Of 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I2=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I2=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I2=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH. CONCLUSION There was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.
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Affiliation(s)
| | - Ching-Hui Sia
- National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Benjamin Y Q Tan
- National University of Singapore, Singapore .,National University Health System, Singapore
| | - Jing Mingxue
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Bernard Chan
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Vijay Kumar Sharma
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Andrew Makmur
- National University of Singapore, Singapore.,Diagnostic Imaging, National University Hospital, Singapore
| | - Anil Gopinathan
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Cunli Yang
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Stanley Loh
- National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Sheldon Ng
- National University of Singapore, Singapore.,Diagnostic Imaging, National University Health System, Singapore
| | - Shao Jin Ong
- National University of Singapore, Singapore.,Department of Diagnostic Imaging, National University Health System, Singapore
| | - Hock-Luen Teoh
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Rahul Rathakrishnan
- National University of Singapore, Singapore.,National University Health System, Singapore
| | - Tommy Andersson
- Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium.,Department of Neuroradiology and Department of Clinical Neuroscience, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital Linkou Branch, Gueishan, Taoyuan, Taiwan
| | - Volker Maus
- Knappschaftskrankenhaus Bochum Langendeer, Bochum, Germany
| | - Lukas Meyer
- Diagnostic and Interventional Neuroradiology, Universitatsklinikum Hamburg Eppendorf Klinik und Poliklinik fur Neuroradiologische Diagnostik und Intervention, Hamburg, Germany
| | | | - Oliver Spooner
- Department of Interventional Neuroradiology, Royal London Hospital, London, London, UK
| | - Tony Yw Li
- National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Rodney Yh Soh
- National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore
| | - Leonard Ll Yeo
- National University of Singapore, Singapore.,National University Health System, Singapore
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