Dataset Information

Effects of hypertension in patients receiving mechanical thrombectomy: A meta-analysis.

ABSTRACT:

Background

Available evidence shows conflicting results with regard to a potential detrimental effect of hypertension on clinical outcomes in patients who undergo mechanical thrombectomy (MT). We performed a meta-analysis to evaluate the impact of hypertension on the prognosis of patients with acute ischaemic stroke (AIS) treated by MT.

Methods

We systematically reviewed previous studies in the PubMed, EMBASE, and Cochrane library databases that reported MT outcomes in AIS patients and their relationships with hypertension or blood pressure. We used a poor outcome (modified Rankin score >2 at 3 months) as the primary end point. Mortality and symptomatic intracranial hemorrhage were the secondary end points. We incorporated a random effect for trials in all models.

Results

Data from 6650 patients in 31 articles that evaluated the effect of hypertension or blood pressure on outcomes after MT were included. Compared with patients without hypertension, patients with hypertension had significantly higher odds of a poor outcome (odds ratio 0.70; 95% confidence interval 0.57-0.85; I = 43%) and higher mortality (odds ratio 1.70; 95% confidence interval 1.26-2.29; I = 33%). Symptomatic intracranial hemorrhage did not differ by patient hypertension status.

Conclusions

The present study confirms that hypertension and high blood pressure are associated with a poor outcome at 3 months after MT in AIS patients. However, the causal relationship between hypertension and a poor outcome remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive blood pressure control.

SUBMITTER: Yuan Z

PROVIDER: S-EPMC7440350 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Publications

Effects of hypertension in patients receiving mechanical thrombectomy: A meta-analysis.

Yuan Zhengzhou Z Chen Ning N Zhou Muke M Guo Jian J Zhang Yanan Y Li Yanbo Y He Li L

Medicine 20200401 16

<h4>Background</h4>Available evidence shows conflicting results with regard to a potential detrimental effect of hypertension on clinical outcomes in patients who undergo mechanical thrombectomy (MT). We performed a meta-analysis to evaluate the impact of hypertension on the prognosis of patients with acute ischaemic stroke (AIS) treated by MT.<h4>Methods</h4>We systematically reviewed previous studies in the PubMed, EMBASE, and Cochrane library databases that reported MT outcomes in AIS patient ...[more]

PMID: 32311996

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Project description:BackgroundYoung patients experience acute ischemic stroke (AIS) at much lower rates than their older counterparts. We performed a systematic review and meta-analysis to assess the question regarding outcomes and clinical characteristics of young stroke patients who underwent mechanical thrombectomy for AIS.MethodsFollowing PRISMA guidelines, a systematic review of the literature was conducted using the databases PubMed, MEDLINE, and Embase. The primary outcome of interest was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcome variables included rate of successful reperfusion (TICI 2b/3), symptomatic intracerebral hemorrhage (sICH), and mortality. Using R software version 4.1.2, we calculated pooled event rates and their corresponding 95% confidence intervals (CI) for all outcomes.ResultsOur analysis included eight studies with a total of 1903 patients. Definitions of young patients included age ranges of 18-49/50 years, 18-54/55 years, and 18-64/65 years. Functional independence was achieved in 62.0% of the patients, with an overall mortality of 9.0%. Moreover, successful reperfusion was achieved in 82.0% of the patients with sICH rates of 5.7%. There was significant heterogeneity among different analyses, which could not be attributed to the differences of the definition of young patients.ConclusionsFollowing mechanical thrombectomy for AIS, patients aged 18-65 years achieved relatively high rates of functional independence and successful reperfusion and low rates of mortality and sICH.Clinical Perspective In this systematic review and meta-analysis of eight studies, we examined outcomes in young stroke patients, aged 18-65 years old, following mechanical thrombectomy for acute ischemic stroke. We found that young patients achieved high rates of functional independence, high rates of successful reperfusion, and low rates of mortality and symptomatic intracerebral hemorrhage.While there have been several papers examining outcomes following mechanical thrombectomy for acute ischemic stroke in young patients, the results of these studies have yet to be pooled together in a meta-analysis. Our results indicate that young patients have good outcomes following mechanical thrombectomy. Further studies that examine these outcomes are warranted so that a higher-powered analysis can be performed to better informed clinicians regarding outcomes in this patient age-group cohort.

Project description:The benefits of mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) and a large ischemic core (LIC) at presentation are uncertain. We aimed to obtain up-to-date aggregate estimates of the outcomes following MT in patients with volumetrically assessed LIC. We conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-conformed, PROSPERO-registered, systematic review and meta-analysis of studies that included patients with AIS and a baseline LIC treated with MT, reported ischemic core volume quantitatively, and included patients with a LIC defined as a core volume ≥50 mL. The search was restricted to studies published between January 2015 and June 2020. Random-effects-meta-analysis was used to assess the effect of MT on 90-day unfavorable outcome (i.e., modified Rankin Scale [mRS] 3-6), mortality, and symptomatic intracranial hemorrhage (sICH) occurrence. Sensitivity analyses were performed for imaging-modality (computed tomography-perfusion or magnetic resonance-diffusion weighted imaging) and LIC-definition (≥50 or ≥70 mL). We analyzed 10 studies (954 patients), including six (682 patients) with a control group, allowing to compare 332 patients with MT to 350 who received best-medical-management alone. Overall, after MT the rate of patients with mRS 3-6 at 90 days was 74% (99% confidence interval [CI], 67 to 84; Z-value=7.04; I2=92.3%) and the rate of 90-day mortality was 36% (99% CI, 33 to 40; Z-value=-7.07; I2=74.5). Receiving MT was associated with a significant decrease in mRS 3-6 odds ratio (OR) 0.19 (99% CI, 0.11 to 0.33; P<0.01; Z-value=-5.92; I2=62.56) and in mortality OR 0.60 (99% CI, 0.34 to 1.06; P=0.02; Z-value=-2.30; I2=58.72). Treatment group did not influence the proportion of patients experiencing sICH, OR 0.96 (99% CI, 0.2 to 1.49; P=0.54; Z-value=-0.63; I2=64.74). Neither imaging modality for core assessment, nor LIC definition influenced the aggregated outcomes. Using aggregate estimates, MT appeared to decrease the risk of unfavorable functional outcome in patients with a LIC assessed volumetrically at baseline.

Project description:BackgroundMechanical thrombectomy (MT) is the cornerstone for treating acute ischemic stroke (AIS) in emergency cases. However, 3-9% of patients display reocclusion in the recanalized vessels within 24 hours after performing MT. This meta-analysis aimed to further identify the predictors and prognosis of unexpected reocclusion after MT.MethodsAccording to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched several literature databases, including PubMed, Embase, and Cochrane, for publications related to the subject term "thrombectomy" that were published prior to March 2020. Pooled analysis was performed with the fixed-effects model using the Mantel-Haenszel method if the heterogeneity was expected to be available (I2≤50%). Otherwise, the random-effects model computed by the DerSimonian-Laird method was used (I2>50%). R software (http://www.r-project.org) was used for analysis in this study.ResultsA total of five articles comprising 1,883 patients (126 patients with reocclusion, 1,757 patients without reocclusion) who were confirmed to have AIS and who underwent emergency MT were finally included in this study. The pooled analysis (reocclusion versus non-reocclusion) showed that atrial fibrillation [odds ratio (OR), 0.36; 95% confidence interval (CI), 0.20-0.63], cardiogenic embolism (OR, 0.35; 95% CI, 0.20-0.63), long-term statin use (OR, 0.39; 95% CI, 0.21-0.75), long-term antiplatelet use (OR, 0.53; 95% CI, 0.31-0.92), and target occlusion at middle cerebral artery-M1 (MCA-M1) (OR, 0.39; 95% CI, 0.19-0.77) might prevent reocclusion and longer onset-to-reperfusion time (mean difference, 66.51; 95% CI, 36.66-96.35) might promote reocclusion after MT performance. Furthermore, the clinical outcomes including early neurological deterioration (OR, 4.87; 95% CI, 2.08-11.40), 90-day modified Rankin Scale score ≤2 (OR, 0.28; 95% CI, 0.18-0.45), and 90-day death rate (OR, 1.85; 95% CI, 1.04-3.29) were also associated with reocclusion after MT performance.ConclusionsAtrial fibrillation, cardiogenic embolism, long-term statin use, long-term antiplatelet use, and target occlusion at MCA-M1 might prevent reocclusion, and longer onset-to-reperfusion time seemed to promote reocclusion after MT. Reocclusion after MT results in a high risk of poor prognosis.

Dataset Information

Effects of hypertension in patients receiving mechanical thrombectomy: A meta-analysis.

Background

Methods

Results

Conclusions

Publications

Effects of hypertension in patients receiving mechanical thrombectomy: A meta-analysis.

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