Efficacy and safety of mechanical thrombectomy in different ages with acute ischemic stroke: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MA Tao , GUO Wengting , SONG Danli , CHEN Yuanyuan , SHAO Kangmei , FAN Zhenzhen ,  GE Zhaoming

Department of Neurology, The Second Hospital of Lanzhou University, Lanzhou 730030, P.R.China;

Corresponding author：

GE Zhaoming, Email: 13893285120@163.com

Keywords：

Ischemic stroke; Mechanical thrombectomy; Meta-analysis; Systematic review; Randomized controlled trial; Non-randomized controlled trial

DOI：

10.7507/1672-2531.201908076

Video：

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Objectives To systematically review the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages.Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) on the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages from inception to August, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.Results A total of 13 studies involving 2 995 patients were included. The results of meta-analysis showed that compared with the control group, patients aged 80 and above had no statistically significant difference in reperfusion success rates (OR=0.90, 95%CI 0.71 to 1.14, P=0.378), and incidence of symptomatic intracranial hemorrhage (OR=1.30, 95%CI 0.86 to 1.94, P=0.212), however, with higher incidence of arbitrary intracranial bleeding events (OR=1.61, 95%CI 1.28 to 2.04, P<0.001), 3-month mortality (OR=2.14, 95%CI 1.73 to 2.64, P<0.001) and lower good functional prognosis rate at 3 months (OR=0.46, 95%CI 0.30 to 0.71, P<0.001).Conclusions Current evidence suggests that people aged 80 and above can obtain effective perfusion through mechanical thrombectomy, however, the incidence of postoperative adverse outcome events is higher and the prognosis is relatively poor. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： MA Tao, GUO Wengting, SONG Danli, CHEN Yuanyuan, SHAO Kangmei, FAN Zhenzhen, GE Zhaoming. Efficacy and safety of mechanical thrombectomy in different ages with acute ischemic stroke: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(4): 412-417. doi: 10.7507/1672-2531.201908076 Copy

1.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2.	Slawski DE, Salahuddin H, Shawver J, et al. Mechanical thrombectomy in elderly stroke patients with mild-to-moderate baseline disability. Interv Neurol, 2018, 7(5): 246-255.
3.	Mühr O, Persson HC, Sunnerhagen KS. Long-term outcome after reperfusion-treated stroke. J Rehabil Med, 2017, 49(4): 316-321.
4.	Bhaskar S, Stanwell P, Cordato D, et al. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurol, 2018, 18(1): 8.
5.	Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 387(10029): 1723-1731.
6.	Loh Y, Kim D, Shi ZS, et al. Higher rates of mortality but not morbidity follow intracranial mechanical thrombectomy in the elderly. AJNR Am J Neuroradiol, 2010, 31(7): 1181-1185.
7.	Parrilla G, Carreón E, Zamarro J, et al. Recanalization and mortality rates of thrombectomy with stent-retrievers in octogenarian patients with acute ischemic stroke. Cardiovasc Intervent Radiol, 2015, 38(2): 288-294.
8.	Kleine JF, Boeckh-Behrens T, Prothmann S, et al. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg, 2016, 8(7): 671-676.
9.	Broussalis E, Weymayr F, Hitzl W, et al. Endovascular mechanical recanalization of acute ischaemic stroke in octogenarians. Eur Radiol, 2016, 26(6): 1742-1750.
10.	Cohen JE, Gomori JM, Leker RR. Stent retriever-based thrombectomy in octogenarians. Interv Neurol, 2016, 5(3-4): 111-117.
11.	Sallustio F, Koch G, Motta C, et al. Efficacy and safety of mechanical thrombectomy in older adults with acute ischemic stroke. J Am Geriatr Soc, 2017, 65(8): 1816-1820.
12.	Son S, Kang DH, Hwang YH, et al. Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke. Acta Neurochir (Wien), 2017, 159(9): 1663-1669.
13.	Azkune Calle I, Bocos Portillo J, Anton-Ladislao A, et al. Clinical outcome of mechanical thrombectomy for stroke in the elderly. J Stroke Cerebrovasc Dis, 2017, 26(3): 582-588.
14.	Kim DH, Kim SU, Sung JH, et al. Significances and outcomes of mechanical thrombectomy for acute infarction in very elderly patients: a single center experience. J Korean Neurosurg Soc, 2017, 60(6): 654-660.
15.	邓一鸣, 高峰, 孙瑄, 等. 80 岁及以上老年急性缺血性卒中患者支架机械取栓的疗效. 中华老年医学杂志, 2018, 37(2): 143-147.
16.	Alawieh A, Starke RM, Chatterjee AR, et al. Outcomes of endovascular thrombectomy in the elderly: a 'real-world' multicenter study. J Neurointerv Surg, 2019, 11(6): 545-553.
17.	Rezai MK, Advani R, Dalen I, et al. Endovascular Thrombectomy in the elderly: do radiological and clinical outcomes differ from those in younger patients? A prospective single-center experience. Cerebrovasc Dis, 2019, 47(1-2): 65-71.
18.	Kawabata Y, Nakajima N, Miyake H, et al. Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients. Neuroradiol J, 2019, 32(4): 303-308.
19.	Puntonet J, Richard ME, Edjlali M, et al. Imaging findings after mechanical thrombectomy in acute ischemic stroke. Stroke, 2019, 50(6): 1618-1625.
20.	Jeon JP, Kim SE, Kim CH. Endovascular treatment of acute ischemic stroke in octogenarians: a meta-analysis of observational studies. Clin Neurol Neurosurg, 2017, 161: 70-77.
21.	Hilditch CA, Nicholson P, Murad MH, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(5): 887-891.
22.	Pego PM, Nunes AP, Ferreira P, et al. Thrombolysis in patients aged over 80 years is equally effective and safe. J Stroke Cerebrovasc Dis, 2016, 25(6): 1532-1538.
23.	Hwang YH, Kim YW, Kang DH, et al. Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke, 2016, 47(7): 1850-1857.
24.	Chandra RV, Leslie-Mazwi TM, Oh DC, et al. Elderly patients are at higher risk for poor outcomes after intra-arterial therapy. Stroke, 2012, 43(9): 2356-2361.
25.	Boers AMM, Jansen IGH, Beenen LFM, et al. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg, 2018, 10(12): 1137-1142.

1. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2. Slawski DE, Salahuddin H, Shawver J, et al. Mechanical thrombectomy in elderly stroke patients with mild-to-moderate baseline disability. Interv Neurol, 2018, 7(5): 246-255.
3. Mühr O, Persson HC, Sunnerhagen KS. Long-term outcome after reperfusion-treated stroke. J Rehabil Med, 2017, 49(4): 316-321.
4. Bhaskar S, Stanwell P, Cordato D, et al. Reperfusion therapy in acute ischemic stroke: dawn of a new era? BMC Neurol, 2018, 18(1): 8.
5. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 387(10029): 1723-1731.
6. Loh Y, Kim D, Shi ZS, et al. Higher rates of mortality but not morbidity follow intracranial mechanical thrombectomy in the elderly. AJNR Am J Neuroradiol, 2010, 31(7): 1181-1185.
7. Parrilla G, Carreón E, Zamarro J, et al. Recanalization and mortality rates of thrombectomy with stent-retrievers in octogenarian patients with acute ischemic stroke. Cardiovasc Intervent Radiol, 2015, 38(2): 288-294.
8. Kleine JF, Boeckh-Behrens T, Prothmann S, et al. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg, 2016, 8(7): 671-676.
9. Broussalis E, Weymayr F, Hitzl W, et al. Endovascular mechanical recanalization of acute ischaemic stroke in octogenarians. Eur Radiol, 2016, 26(6): 1742-1750.
10. Cohen JE, Gomori JM, Leker RR. Stent retriever-based thrombectomy in octogenarians. Interv Neurol, 2016, 5(3-4): 111-117.
11. Sallustio F, Koch G, Motta C, et al. Efficacy and safety of mechanical thrombectomy in older adults with acute ischemic stroke. J Am Geriatr Soc, 2017, 65(8): 1816-1820.
12. Son S, Kang DH, Hwang YH, et al. Efficacy, safety, and clinical outcome of modern mechanical thrombectomy in elderly patients with acute ischemic stroke. Acta Neurochir (Wien), 2017, 159(9): 1663-1669.
13. Azkune Calle I, Bocos Portillo J, Anton-Ladislao A, et al. Clinical outcome of mechanical thrombectomy for stroke in the elderly. J Stroke Cerebrovasc Dis, 2017, 26(3): 582-588.
14. Kim DH, Kim SU, Sung JH, et al. Significances and outcomes of mechanical thrombectomy for acute infarction in very elderly patients: a single center experience. J Korean Neurosurg Soc, 2017, 60(6): 654-660.
15. 邓一鸣, 高峰, 孙瑄, 等. 80 岁及以上老年急性缺血性卒中患者支架机械取栓的疗效. 中华老年医学杂志, 2018, 37(2): 143-147.
16. Alawieh A, Starke RM, Chatterjee AR, et al. Outcomes of endovascular thrombectomy in the elderly: a 'real-world' multicenter study. J Neurointerv Surg, 2019, 11(6): 545-553.
17. Rezai MK, Advani R, Dalen I, et al. Endovascular Thrombectomy in the elderly: do radiological and clinical outcomes differ from those in younger patients? A prospective single-center experience. Cerebrovasc Dis, 2019, 47(1-2): 65-71.
18. Kawabata Y, Nakajima N, Miyake H, et al. Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients. Neuroradiol J, 2019, 32(4): 303-308.
19. Puntonet J, Richard ME, Edjlali M, et al. Imaging findings after mechanical thrombectomy in acute ischemic stroke. Stroke, 2019, 50(6): 1618-1625.
20. Jeon JP, Kim SE, Kim CH. Endovascular treatment of acute ischemic stroke in octogenarians: a meta-analysis of observational studies. Clin Neurol Neurosurg, 2017, 161: 70-77.
21. Hilditch CA, Nicholson P, Murad MH, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(5): 887-891.
22. Pego PM, Nunes AP, Ferreira P, et al. Thrombolysis in patients aged over 80 years is equally effective and safe. J Stroke Cerebrovasc Dis, 2016, 25(6): 1532-1538.
23. Hwang YH, Kim YW, Kang DH, et al. Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke, 2016, 47(7): 1850-1857.
24. Chandra RV, Leslie-Mazwi TM, Oh DC, et al. Elderly patients are at higher risk for poor outcomes after intra-arterial therapy. Stroke, 2012, 43(9): 2356-2361.
25. Boers AMM, Jansen IGH, Beenen LFM, et al. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg, 2018, 10(12): 1137-1142.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of mechanical thrombectomy in different ages with acute ischemic stroke: a meta-analysis

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