4.4 Article

Efficacy and safety of endovascular thrombectomy in mild ischemic stroke: results from a retrospective study and meta-analysis of previous trials

Journal

BMC NEUROLOGY
Volume 19, Issue -, Pages -

Publisher

BMC
DOI: 10.1186/s12883-019-1372-9

Keywords

Thrombectomy; Stroke; Endovascular; Outcome

Funding

  1. National Natural Science Foundation of China [81530038, 81400993, 81671172, 81701184]
  2. National Key Research and Development Program [2017YFC1307901]
  3. Chinese Postdoctoral Science Fund [2015 M572815]

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BackgroundMechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial.MethodsIn this retrospective study, a total of 177 Chinese patients presenting with MIS (NIHSS <= 8) and LVO between January 2014 and September 2017 from seven comprehensive stroke centers were identified. Odds of good outcome with endovascular thrombectomy versus medical treatment were obtained by logistic regression analysis and propensity-score matching method, and a meta-analysis pooled results from six studies (n=733).ResultsGood outcome (mRS: 0-1) was 58.2% (46/79) in the thrombectomy and 46.9% (46/98) in the medical group, which showed no statistical significance before adjustment (P=0.13; OR=1.57, 95% CI: 0.86 to 2.86). The adjusted ORs of thrombectomy versus medical group were 3.23 (95% CI, 1.35 to 7.73; P=0.008) by multivariable logistic analysis, 2.78 (1.12 to 6.89; P=0.02) by propensity score matching analysis, and 3.20 (1.22 to 8.37; P=0.01) by propensity score matching analysis with additional adjustments, respectively. Thrombectomy treatment did not result in excessive mortality or symptomatic intracranial hemorrhage after adjustments. The meta-analysis did not confirm the associations between good outcome and endovascular treatment.ConclusionsThe current study indicates that endovascular thrombectomy is associated with good functional outcome in MIS patients with LVO, and without additional risk of symptomatic intracranial hemorrhage and mortality. Although the meta-analysis failed to demonstrate its superiority compared to medical treatment, randomized clinical trials are needed.

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