RT Journal Article
SR Electronic
T1 Endovascular therapy for acute ischemic stroke with distal medium vessel occlusion: a systematic review and meta-analysis
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2022-019717
DO 10.1136/jnis-2022-019717
A1 Enver De Wei Loh
A1 Keith Zhi Xian Toh
A1 Gabriel Yi Ren Kwok
A1 Yao Hao Teo
A1 Yao Neng Teo
A1 Claire Goh
A1 Nicholas L Syn
A1 Andrew Fu-Wah Ho
A1 Ching-Hui Sia
A1 Vijay Kumar Sharma
A1 Benjamin YQ Tan
A1 Leonard LL Yeo
YR 2022
UL http://jnis.bmj.com/content/early/2022/12/19/jnis-2022-019717.abstract
AB Aims Endovascular therapy (EVT) for distal medium vessel occlusions (DMVOs) is a potential frontier of acute ischemic stroke (AIS) treatment, but its efficacy against best medical therapy (BMT) remains unknown. We performed a systematic review and meta-analysis evaluating the efficacy and safety of EVT versus BMT in primary DMVO.Methods We systematically searched PubMed, Cochrane Library and Embase, from inception to August 14, 2022, for studies comparing EVT with BMT in DMVO-AIS. We adopted the Distal Thrombectomy Summit Group’s definition of DMVO. Efficacy outcomes were functional independence (90-day modified Rankin Scale (mRS) 0–2) and excellent functional outcomes (90-day mRS 0–1). Safety outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day mortality.Results Fourteen observational and two randomized-controlled studies were included, with 1202 patients receiving EVT and 1267 receiving BMT. After trim-and-fill correction, EVT achieved significantly better odds of functional independence than BMT (adjusted OR 1.61, 95% CI 1.06 to 2.43). There were no significant differences in overall excellent functional outcomes (OR 1.23, 95% CI 0.88 to 1.71), sICH (OR 1.44, 95% CI 0.78 to 2.66), and mortality (OR 1.03, 95% CI 0.73 to 1.45). Stratified by EVT method, mechanical thrombectomy±intra-arterial thrombolysis achieved more excellent functional outcomes than BMT (OR 1.59, 95% CI 1.13 to 2.23). In mild strokes (National Institutes of Health Stroke Scale score <6), EVT caused significantly more sICH (OR 6.30, 95% CI 1.55 to 25.64).Conclusions EVT shows promising efficacy benefit over BMT for primary DMVO-AIS. Further randomized controlled trials are necessary to evaluate the efficacy and safety of EVT in DMVO-AIS.All data relevant to the study are included in the article or uploaded as supplementary information.