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Licensed Unlicensed Requires Authentication Published by De Gruyter September 15, 2020

Efficacy and safety of endovascular treatment for patients with acute intracranial atherosclerosis–related posterior circulation stroke: a systematic review and meta-analysis

Jiajia Bao, Ye Hong, Chaohua Cui, Mengmeng Ma, Lijie Gao, Qian Liu, Ning Chen and Li He

Abstract

The benefit of endovascular treatment (EVT) for patients with intracranial atherosclerosis–related large vessel occlusion (ICAS-LVO) in posterior circulation stroke (PCS) is inconsistent. This systematic review and meta-analysis were conducted to estimate the effect of ICAS-LVO in PCS treated by EVT. A systematic review was completed, tracking studies from their date of inception until February 2020. Clinical studies which compared outcomes after EVT for ICAS-LVO and non–ICAS-LVO in PCS were included. Data were synthesized and interpreted from meta-analysis. A total of 688 patients (352 ICAS-LVO and 336 non–ICAS-LVO) in the eight studies were included. The successful reperfusion rate (odds ratio [OR], 0.58; 95% confidence intervals [95% CIs], 0.37–0.93; P = 0.02) was lower in PCS with ICAS-LVO than non–ICAS-LVO. And for other clinical outcomes, there were no differences between both groups. Moreover, there were no statistical differences of any clinical outcome among subgroups stratified by nations and target vessel occlusion location. With respect to patients’ characteristics, age (mean difference [MD], −2.75; 95% CI, −4.62–−0.88; P = 0.004), pc-Alberta Stroke Program Early CT Score (MD, −0.49; 95% CI, −0.94–−0.05; P = 0.03), distributions of sex (male) (OR, 2.34; 95% CI, 1.53–3.56; P < 0.001), prior or current smoking (OR, 1.85; 95% CI, 1.12–3.07; P = 0.02), hypertension (OR, 2.06; 95% CI, 1.32–3.22; P = 0.002), coronary artery disease (OR, 0.27; 95% CI, 0.11–0.66; P = 0.004) and general anesthesia (OR, 2.89; 95% CI, 1.54–5.45; P = 0.001) were statistically different between both groups. In conclusion, more targeted assessments are warranted for patients with ICAS-LVO–related PCS during clinical strategies, and the benefit of EVT for PCS with ICAS-LVO deserves further research.


Corresponding author: Li He, Department of Neurology, West China Hospital, Sichuan University, No. 37, Wainan Guoxue Xiang, Chengdu 610041, Sichuan, China, E-mail:

Jiajia Bao and Ye Hong: These authors contributed equally to this article.


Funding source: National Key R&D Program of China

Award Identifier / Grant number: 2018YFC1311400 and 2018YFC1311401

Funding source: National Natural Science Foundation of China

Award Identifier / Grant number: 81772435

Award Identifier / Grant number: 81971162

  1. Author contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: This project was supported by National Key R&D Program of China (2018YFC1311400 and 2018YFC1311401); the National Natural Science Foundation of China (81772435); the National Natural Science Foundation of China (81971162).

  3. Conflict of interest statement: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Supplementary material

The online version of this article offers supplementary material (https://doi.org/10.1515/revneuro-2020-0025).

Received: 2020-04-14
Accepted: 2020-06-21
Published Online: 2020-09-15
Published in Print: 2021-01-27

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