Photo Credit: Sittithat Tangwitthayaphum
The following is a summary of “Endovascular thrombectomy for DAWN- and DEFUSE-3 ineligible acute ischemic stroke patients: a systematic review and meta-analysis,” published in the February 2024 issue of Neurology by Morsi et al.
Endovascular thrombectomy (EVT) shows promise for acute ischemic strokes (AIS) with large vessel occlusion (LVO) treated within 6-24h, prompting studies beyond DAWN/DEFUSE-3 criteria.
Researchers conducted a retrospective study to compare outcomes of EVT for late-window LVO strokes in DAWN/DEFUSE-3 eligible (DD) ineligible (NDND) patients.
They conducted a systematic review and meta-analysis, investigating the outcomes of EVT for patients with late-window anterior circulation LVO beyond 6 hours. Patients were categorized as DD-3 eligible or NDND. The search across PubMed, Embase, Web of Science, and Scopus found 464 records. After removing duplicates, 298 studies were screened, including and analyzing nine. The analysis focused on characteristics, baseline comparisons, risk of bias, and outcomes.
The results showed baseline characteristics (age, gender, most comorbidities, NIHSS score, and ASPECTS) between DD-3 eligible and NDND patients. NDND patients had a higher incidence of atrial fibrillation and larger infarct volumes on baseline imaging. Reperfusion rates (TICI 2b-3) were similar between DD and NDND (354/469 vs 364/459, OR = 0.86; 95% CI 0.40, 1.84; P=0.689), with significant heterogeneity (I 2 = 73%, P=0.002). The proportion of distal occlusions was higher in NDND than in DD (137/347 vs 47/428, respectively), with significant heterogeneity (I 2 = 85%, P=0.023). Functional independence at 90 days (mRS 0–2) showed no significant difference (259/802 vs 197/668, OR = 1.12; 95% CI 0.77, 1.63; P=0.552), with notable heterogeneity (I 2 = 46%, P=0.063). Symptomatic intracranial hemorrhage (sICH) rates were lower in DD (14/309 vs 47/400, OR = 0.49; 95% CI 0.25, 0.93; P=0.029) with no heterogeneity (I 2 = 0%, P=0.552). 90-day mortality was lower in DD (43/304 vs 107/399, OR = 0.55; 95% CI 0.37, 0.82; P=0.004) with no significant heterogeneity (I 2 = 0%, P=0.536).
They concluded that EVT offered similar functional outcomes regardless of DD-3 eligibility, but higher complication rates in NDND patients imply cautious selection and further research for optimal eligibility criteria.
Source: link.springer.com/article/10.1007/s00415-024-12198-3
