Mechanical Thrombectomy for Mild Acute Ischemic Stroke with Large-Vessel Occlusion: A Systematic Review and Meta-Analysis

BACKGROUND

The functional prognosis of mechanical thrombectomy (MT) for mild acute ischemic stroke (AIS) with large-vessel occlusion (LVO) is controversial. To explore a more precise estimation, a meta-analysis was conducted.

METHODS

The relevant studies were identified by searching PubMed, Embase, Web of Science, and Cochrane Collaboration Database until October 2021. The pooled analysis, subgroup analysis, sensitivity analysis, and publication bias examination were all conducted. The meta-analysis was performed by using Stata 12.0.

RESULTS

Eleven studies were included with a total of 1,929 subjects, including 794 patients receiving MT and 1,135 patients receiving medical management. The pooled analysis showed that MT might be not associated with functional prognosis among mild AIS with LVO (excellent functional prognosis: risk ratio (RR) = 1.07, 95% confidence interval (CI) = 0.94-1.21, p = 0.294; favorable functional prognosis: RR = 1.01, 95% CI = 0.96-1.06, p = 0.823). The statistical stability and reliability were demonstrated by the sensitivity analysis and publication bias outcomes.

CONCLUSION

Our meta-analysis suggests that MT may be not associated with functional prognosis of mild AIS with LVO.

Trends in cognitive function assessed by a battery of neuropsychological tests after mild acute ischemic stroke

OBJECTIVE

The aim of this study is to investigate the domain-specific trends of cognitive function up to 12 months after mild acute ischemic stroke.

METHODS

Enrolment of consecutive cohort of patients with mild acute ischemic stroke with recorded clinical characteristics and extensive neuropsychological assessments, including five cognitive domains. The Montreal cognitive assessment of the Beijing version (MoCA-Bj) was used to assess overall cognition. All patients completed all domain-specific examinations were categorised into three groups according to the time between the stroke onset and neuropsychological profiling, the time duration including less than one month (n = 174), one month to six months (n = 65) and over six months (n = 39).

RESULTS

The final cohort consisted of 278 patients. The executive (χ² = 6.95, P<0.05) and memory dysfunctions (χ² = 9.6, P<0.01) showed strong improvement, especially in executive function, which prevalence was 48.85% at <1- month group and 25.64% at >6 months group. The prevalence of attention and information processing also had a declining trend, the differences, however, were not statistically significant (χ² = 0.23 and 2.25, respectively, P>0.05). There was no significant change in language function (χ² = 0.46, P>0.05) and the MoCA (χ² = 0.59, P>0.05) at 3-time point groups. In 195 first-ever stroke patients, the results of memory (χ² = 6.94 P<0.05) and executive dysfunctions (χ² = 6.25 P<0.05) also showed significant improvement.

CONCLUSION

There is varying degree of improvement tendency in executive and memory dysfunctions after mild acute ischemic stroke. Early cognitive assessments after mild acute ischemic stroke do not reflect the cognitive level of stable period.