AUTHOR=Adamou Antonis , Gkana Androniki , Mavrovounis Georgios , Beltsios Eleftherios T. , Kastrup Andreas , Papanagiotou Panagiotis 

TITLE=Outcome of Endovascular Thrombectomy in Pre-stroke Dependent Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.880046

DOI=10.3389/fneur.2022.880046

ISSN=1664-2295

ABSTRACT=Introduction
Endovascular thrombectomy (EVT) is a well-established and effective therapeutic option for patients that meet certain criteria. However, this modality is not well studied in patients with pre-existing disability. The aim of the present study was to investigate the impact of mechanical thrombectomy in patients with acute onset ischemic stroke and pre-stroke dependency (PSD) in regard to their clinical outcome and mortality.
Materials & Methods
The MEDLINE, Scopus, and Cochrane Library databases were comprehensively searched with a cut-off date of December 11th, 2021. We performed meta-analysis to investigate the 90-day clinical outcome, the 90-day mortality, and the rate of symptomatic intracerebral haemorrhage (sICH) between the PSD (modified Rankin Scale score ≥ 3) and non-PSD (modified Rankin Scale score = 0-2) groups who underwent EVT for acute onset ischemic stroke.
Results
Six studies were included in the meta-analysis involving 4543 cases with no PSD and 591 cases with PSD. The non-PSD group showed a statistically significant better clinical outcome at 90 days compared to the PSD group [RR (95% CI) = 1.44 (1.06, 1.85); pz = 0.02]. The non-PSD group demonstrated a statistically significant higher risk of death at 90 days in comparison to the PSD group [RR (95% CI) = 0.45 (0.41, 0.50); pz < 0.01]. Lastly, the rate of sICH was comparable between the two groups [RR (95% CI) = 0.89 (0.64, 1.24); pz = 0.48].
Discussion
We report a higher rate of unfavourable clinical outcome and a higher mortality rate in patients with PSD undergoing EVT compared to those with no previous disability. However, there was a significant proportion of PSD cases who fared well post-procedurally and should not be routinely excluded from mechanical thrombectomy.