3 research outputs found
Supplementary Material for: Mechanical Thrombectomy for Middle Cerebral Artery Division Occlusions: A Systematic Review and Meta-Analysis
<p><b><i>Background:</i></b> Middle cerebral artery division (M2)
occlusion was significantly underrepresented in recent mechanical
thrombectomy (MT) randomized controlled trials, and the approach to this
disease remains heterogeneous. <b><i>Objective:</i></b> To conduct a
systematic review and meta-analysis of outcomes at 90 days among
patients undergoing MT for M2 middle cerebral artery (MCA) occlusions. <b><i>Methods:</i></b>
Five clinical databases were searched from inception through September
2016. Observational studies reporting 90-day modified Rankin Scale
scores for patients undergoing MT for M2 MCA occlusions with an M1 MCA
control group were selected. The primary outcome of interest was good
clinical outcome 90 days after MT of an M1 or M2 MCA occlusion.
Secondary outcomes of interest included mortality and excellent clinical
outcome, recanalization rates, significant intracerebral hemorrhage,
and procedural complications. <b><i>Results:</i></b> A total of 323
publications were identified, and 237 potentially relevant articles were
screened. Six studies were included in the analysis (M1 = 1,203, M2 =
258; total <i>n</i> = 1,461). We found no significant differences in
good clinical outcomes (1.10 [95% CI, 0.83-1.44]), excellent clinical
outcomes (1.07 [0.65-1.79]), mortality at 3 months (0.85 [0.58-1.24]),
recanalization rates (1.06 [0.32-3.48]), and significant intracranial
hemorrhage (1.19 [0.61-2.30]). <b><i>Conclusions:</i></b> MT of M2 MCA
occlusions is as safe as that of main trunk MCA occlusions, and
comparable in terms of clinical outcomes and hemorrhagic complications.
Randomized clinical trials are needed to assess the impact of MT in
patients with M2 occlusions, given that M1 MCA occlusions have different
natural histories than M2 occlusions.</p
Supplementary Material for: Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability
<b><i>Background:</i></b> The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. <b><i>Methods:</i></b> Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. <b><i>Results:</i></b> Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, <i>p</i> = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, <i>p</i> = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, <i>p</i> = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (<i>p</i> < 0.001 and <i>p</i> = 0.009, respectively). <b><i>Conclusion:</i></b> Advanced age, baseline disability, and delayed treatment are associated with subÂoptimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment
Supplementary Material for: Mechanical Thrombectomy in Elderly Stroke Patients with Mild-to-Moderate Baseline Disability
<b><i>Background:</i></b> The number of elderly patients suffering from ischemic stroke is rising. Randomized trials of mechanical thrombectomy (MT) generally exclude patients over the age of 80 years with baseline disability. The aim of this study was to understand the efficacy and safety of MT in elderly patients, many of whom may have baseline impairment. <b><i>Methods:</i></b> Between January 2015 and April 2017, 96 patients ≥80 years old who underwent MT for stroke were selected for a chart review. The data included baseline characteristics, time to treatment, the rate of revascularization, procedural complications, mortality, and 90-day good outcome defined as a modified Rankin Scale (mRS) score of 0–2 or return to baseline. <b><i>Results:</i></b> Of the 96 patients, 50 had mild baseline disability (mRS score 0–1) and 46 had moderate disability (mRS score 2–4). Recanalization was achieved in 84% of the patients, and the rate of symptomatic hemorrhage was 6%. At 90 days, 34% of the patients had a good outcome. There were no significant differences in good outcome between those with mild and those with moderate baseline disability (43 vs. 24%, <i>p</i> = 0.08), between those aged ≤85 and those aged > 85 years (40.8 vs. 26.1%, <i>p</i> = 0.19), and between those treated within and those treated beyond 8 h (39 vs. 20%, <i>p</i> = 0.1). The mortality rate was 38.5% at 90 days. The Alberta Stroke Program Early CT Score (ASPECTS) and the National Institutes of Health Stroke Scale (NIHSS) predicted good outcome regardless of baseline disability (<i>p</i> < 0.001 and <i>p</i> = 0.009, respectively). <b><i>Conclusion:</i></b> Advanced age, baseline disability, and delayed treatment are associated with subÂoptimal outcomes after MT. However, redefining good outcome to include return to baseline functioning demonstrates that one-third of this patient population benefits from MT, suggesting the real-life utility of this treatment