ఆంజియాలజీ: ఓపెన్ యాక్సెస్
అందరికి ప్రవేశం

నైరూప్య

Endovascular Treatment versus Medical Management in Patients with Large Vessel Occlusion and Prestroke Disability

Tian-Yi Zhang, Dian Li, Yi-Qiao Hu, Heng-Zhu Zhang

Background: Stroke physicians often encounter a treatment dilemma when caring for patients with premorbid disabilities, who are typically excluded from randomized controlled trials focusing on Endovascular Treatment (EVT) for Large Vessel Occlusion (LVO). This study aims to compare the effectiveness and safety of EVT versus Medical Management (MM) in these particular patients.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library for articles related to EVT in LVO patients with a prestroke modified Rankin Scale (mRS) score>1. The search spanned from the inception of these databases until July 19, 2023. The primary outcome measure was functional recovery, defined as a return to at least the prestroke mRS score within 90 days. Secondary outcomes included symptomatic intracranial hemorrhage and mortality rates at 90 days. Meta-analyses were conducted using random-effects models.

Results: The meta-analysis included six cohort studies comprising 2106 patients. In comparison to patients undergoing MM, those treated with EVT exhibited a greater likelihood of achieving functional recovery (4 studies; 1560 patients; risk ratio: 2.21; 95% confidence interval, 1.36 to 3.61; p=0.001; I2=69%) and lower mortality rates (6 studies, 2106 patients, risk ratio: 0.76; 95% confidence interval, 0.67 to 0.86, p=0.0001, I2= 13%) at the 90-day mark. Both sets of results were extremely statistically significant. Significant difference was also observed in terms of symptomatic intracranial hemorrhage between the two groups (5 studies, 1791 patients, risk ratio: 2.28, 95% confidence interval, 1.03 to 5.01, p=0.04, I2=29%).

Conclusion: For patients with LVO and a prestroke mRS score>1, although EVT results in a higher risk of bleeding, it improves the chance of a good functional outcome and reduces the risk of death. The practice of denying EVT solely on the basis of premorbid disability may not be justified.