Endovascular thrombectomy for large vessel occlusion in acute ischemic stroke patients with concomitant intracranial hemorrhage

Abstract

Background

Endovascular thrombectomy (EVT) is the gold standard for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, concomitant intracranial hemorrhage (ICH) might render AIS-LVO patients ineligible for EVT in real-life practice.

Objective

To provide robust evidence regarding the outcomes of EVT in AIS-LVO patients with concomitant ICH.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Data analysis was performed using OpenMetaAnalyst software. We assessed the pooled incidence rate with a 95 % confidence interval (CI) for qualitative data and analyzed the pooled mean difference (MD) with a 95 % CI for continuous data. The pooled effect size for all outcomes was calculated using the DerSimonian and Laird random-effects model.

Results

Six studies were included in the meta-analysis. The overall incidence rate of successful revascularization was 85.3 % (95 % CI: 75.8 %-94.7 %), with rates of 76.1 % for ipsilateral hemorrhages and 66.1 % for contralateral hemorrhages. Functional independence was achieved in 20 % of patients (95 % CI: 4.8 %-36.8 %), with rates of 23 % for ipsilateral and 27.7 % for contralateral hemorrhages. Mortality was reported at 52 % (95 % CI: 34.9 %-69 %), with a higher rate of 52.6 % for ipsilateral hemorrhages compared to 36.8 % for contralateral hemorrhages.

Conclusion

This meta-analysis indicates that EVT is feasible in AIS patients with concurrent ICH, yet it is associated with poor functional outcomes and high mortality rates. Careful patient selection is essential to optimize the outcomes, and further research is needed to enhance outcomes for these high-risk patients.