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A meta-analysis of collateral status and outcomes of mechanical thrombectomy
Jiacheng Qian1,2, Lu Fan1,3, Weiqing Zhang1,3
1Department of Neurology, Cerebrovascular Disease Center, People's Hospital, China Medical University, Shenyang, China.
Insights
Good pretreatment collaterals in patients with acute ischemic stroke undergoing mechanical thrombectomy are linked to better functional independence and successful reperfusion. This systematic review highlights the positive impact of robust collateral circulation on patient outcomes.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Mechanical thrombectomy is a key treatment for acute ischemic stroke caused by large-vessel occlusion in the anterior circulation.
- Pretreatment collateral status is a potential predictor of treatment response and patient outcomes.
- Understanding the role of collaterals can optimize patient selection and treatment strategies.
Purpose of the Study:
- To systematically review and meta-analyze the association between pretreatment collateral status and outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy.
- To evaluate the impact of good collaterals on functional independence, symptomatic intracranial hemorrhage, mortality, and successful reperfusion.
Main Methods:
- Systematic literature search of Embase, PubMed, and Cochrane Library up to March 5, 2020.
- Inclusion of 34 studies with 5768 patients.
- Random-effects model meta-analysis to synthesize pooled relative risk and 95% confidence intervals.
Main Results:
- Good collaterals were significantly associated with improved functional independence (mRS 0-2) (RR 1.93).
- Good collaterals correlated with successful reperfusion (RR 1.23) and decreased symptomatic intracranial hemorrhage (RR 0.68).
- Patients with good collaterals had significantly lower mortality rates (RR 0.37).
Conclusions:
- Good pretreatment collateral circulation is a significant positive predictor of functional independence after mechanical thrombectomy.
- Robust collateral status is associated with higher rates of successful reperfusion and reduced risk of symptomatic intracranial hemorrhage.
- Pretreatment collaterals are crucial for favorable outcomes, including reduced mortality, in anterior circulation large-vessel occlusion stroke patients receiving mechanical thrombectomy.
Objectives:
To perform a systematic review and meta-analysis to investigate pretreatment collaterals and outcomes of mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion in anterior circulation.
Methods:
We systematically searched Embase, PubMed, and the Cochrane Library from their dates of inception to March 5, 2020, and also manually searched reference lists of relevant articles. Pooled relative risk with 95% confidence interval on the association between good collaterals and functional independence (in terms of mRS 0-2), symptomatic intracranial hemorrhage, mortality, and successful reperfusion were synthesized using a random-effects model.
Results:
Thirty-four studies enrolling 5768 patients were included in analysis. Good collaterals were significantly associated with functional independence (RR 1.93, 95%CI 1.64-2.27, P < .0001), successful reperfusion (RR 1.23, 95%CI 1.12-1.35, P < .0001), decreased rate of symptomatic intracranial hemorrhage (RR 0.68, 95%CI 0.47-0.97, P = .032), and mortality (RR 0.37, 95%CI 0.27-0.52, P < .0001). The results were consistent in sensitivity analysis. The associations between good collaterals and reperfusion remained stable after adjusting for publication bias.
Conclusions:
Good pretreatment collaterals were associated with functional independence, successful reperfusion, and decreased rate of sICH and mortality after receiving mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion.
