Efficacy and safety of endovascular treatment vs medical treatment in anterior circulation stroke beyond 6 Hours: A systematic review and metaanalysis

Zixu Zhao; Xin Jiang; Ying Zhang; Zixiao Yin; Guohui Lu; Yang Wang; Michael Hall; Lingfeng Lai

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Efficacy and safety of endovascular treatment vs medical treatment in anterior circulation stroke beyond 6 Hours: A systematic review and metaanalysis

Author: Zixu Zhao ¹ ; Xin Jiang ² ; Ying Zhang ² ; Zixiao Yin ³ ; Guohui Lu ¹ ; Yang Wang ¹ ; Michael Hall ⁴ ; Lingfeng Lai ¹
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1. Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang
2. The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi
3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
4. Institute of Ophthalmology, University College London, London, UK
Publication Type:Journal Article
Keywords: Endovascular procedure; cerebral artery; stroke; perfusion imaging
From:Neurology Asia 2020;25(4):439-446
CountryMalaysia
Language:English
Abstract: Background & Objective: Endovascular treatment is the widely accepted treatment for patients with anterior circulation stroke within 6 hours of onset of stroke. We aimed to evaluate the advantages of endovascular treatment compared to standard medical treatment in treating patients with anterior circulation stroke beyond the 6-hour therapeutic window. Methods: We reviewed the literature concerning endovascular treatment versus medical treatment beyond the 6-hour therapeutic window. Using random-effects meta-analysis, we evaluated the following outcomes: modified Rankin scale in the three-month follow-up [excellent outcome (mRS≤1), functional independence (mRS≤2), moderate outcome(mRS≤3)], recanalization rate at 24 hours, mortality at 90 days or in-hospital, symptomatic intracranial hemorrhage, parenchymal hematoma type 2 and hemorrhagic infarction 1. Results: Four studies including 642 patients were evaluated. Endovascular treatment was associated with higher odds of excellent outcome (OR 2.55; 95% CI 1.48 to 4.41,), functional independence (OR 3.64; 95% CI 2.43 to 5.45), moderate outcome (OR 2.70; 95% CI 1.95-3.74) and recanalization rate at 24 hours (OR 8.81; 95%CI 2.81 to 27.69) compared to MT. No difference in the rates of mortality, symptomatic intracranial hemorrhage, parenchymal hematoma type 2 or hemorrhagic infarction 1 was found between the 2 groups. Studies using strict perfusion imaging inclusion selection showed better moderate outcome in comparison to the studies without perfusion imaging inclusion selection (P <0.012). Conclusion: Our study highlights the superiority of endovascular treatment over standard medical treatment alone for treating patients with anterior circulation stroke beyond 6 hours since stroke onset, although more studies are required for further investigation. Standard of strict selection for eligible patients before endovascular treatment should be based on DAWN or DEFFUSE 3 inclusion criteria.
Full text:7.2020my0064.pdf