Risultati per: Infezione da Helicobacter pylori: review

Stroke, Ahead of Print. Background:Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA.Methods:Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the CochranQandI2statistics.Results:We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%–60%]; I2=93%), cortical superficial siderosis (49% [95% CI, 38%–59%]; I2=95%), dementia or mild cognitive impairment (50% [95% CI, 35%–65%]; I2=97%), intracerebral hemorrhage (ICH; 44% [95% CI, 27%–61%]; I2=98%), transient focal neurological episodes (48%; 10 studies [95% CI, 29%–67%]; I2=97%), lacunar infarcts (30% [95% CI, 25%–36%]; I2=78%), high grades of perivascular spaces located in centrum semiovale (56% [95% CI, 44%–67%]; I2=88%) and basal ganglia (21% [95% CI, 2%–51%]; I2=98%), and white matter hyperintensities with moderate or severe Fazekas score (53% [95% CI, 40%–65%]; I2=91%). The only neuroimaging marker that was associated with higher odds of recurrent ICH was cortical superficial siderosis (odds ratio, 1.57 [95% CI, 1.01–2.46]; I2=47%). Sensitivity analyses demonstrated a higher prevalence of ICH (53% versus 16%;P=0.03) and transient focal neurological episodes (57% versus 17%;P=0.03) among retrospective studies compared with prospective studies. No difference was documented between the prevalence rates based on the CAA status.Conclusions:Approximately one-half of hospital-based cohort of CAA patients was observed to have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, ICH, or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker that was associated with higher odds of ICH recurrence. Future population-based studies among well-defined CAA cohorts are warranted to corroborate our findings.

Stroke, Ahead of Print. Background:Cerebral venous thrombosis (CVT) has recently been reported as a common thrombotic manifestation in association with vaccine-induced thrombotic thrombocytopenia, a syndrome that mimics heparin-induced thrombocytopenia (HIT) and occurs after vaccination with adenovirus-based SARS-CoV-2 vaccines. We aimed to systematically review the incidence, clinical features, and prognosis of CVT occurring in patients with HIT.Methods:The study protocol was registered with PROSPERO (CRD42021249652). MEDLINE, EMBASE and Cochrane CENTRAL were searched up to June 1, 2021 for HIT case series including >20 patients, or any report of HIT-related CVT. Demographic, neuroradiological, clinical, and mortality data were retrieved. Meta-analysis of proportions with random-effect modeling was used to derive rate of CVT in HIT and in-hospital mortality. Pooled estimates were compared with those for CVT without HIT and HIT without CVT, to determine differences in mortality.Results:From 19073 results, we selected 23 case series of HIT (n=1220) and 27 cases of HIT-related CVT (n=27, 71% female). CVT developed in 1.6% of 1220 patients with HIT (95% CI,1.0%–2.5%,I2=0%). Hemorrhagic brain lesions occurred in 81.8% of cases of HIT-related CVT and other concomitant thrombosis affecting other vascular territory was reported in 47.8% of cases. In-hospital mortality was 33.3%. HIT-related CVT carried a 29% absolute increase in mortality rate compared with historical CVT controls (33.3% versus 4.3%,P

Stroke, Ahead of Print. The stroke burden continues to grow across the globe, disproportionally affecting developing countries. This burden cannot be effectively halted and reversed without effective and widely implemented primordial and primary stroke prevention measures, including those on the individual level. The unprecedented growth of smartphone and other digital technologies with digital solutions are now being used in almost every area of health, offering a unique opportunity to improve primordial and primary stroke prevention on the individual level. However, there are several issues that need to be considered to advance development and use this important digital strategy for primordial and primary stroke prevention. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines we provide a systematic review of the current knowledge, challenges, and opportunities of digital health in primordial and primary stroke prevention.

Stroke, Ahead of Print. Background:Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function.Methods:Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome.Results:Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69–2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27–0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67–15.32]) and balance (MD, 2.97 [95% CI, 0.71–5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53–27.04) and functional status (MD, 14.02 [95% CI, 8.41–19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, −0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, −1.33 to 2.23]) had a significant effect on cognitive function compared with standard care.Conclusions:There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.

Stroke, Volume 53, Issue Suppl_1, Page AWP221-AWP221, February 1, 2022. Background:Early diagnosis through symptom recognition is vital in acute stroke management. However, women who experience stroke are more likely than men to receive a missed or delayed diagnosis.Aims:To assess sex differences in the symptom presentation of stroke and whether these differences are associated with a delayed or missed diagnosis.Methods:PubMed, EMBASE and the Cochrane Library were systematically searched up to January 2021 for all studies that reported on symptoms in both adult women and men with diagnosed stroke (ischaemic or haemorrhagic) and transient ischaemic attack and were published in English. Sex-stratified proportions for each symptom were extracted and pooled. The relative risk (RR) of a symptom being present in women relative to men with 95% confidence intervals (CI) was also calculated and pooled, as well as the RR of a delayed or missed stroke diagnosis.Results:Pooled results from 21 eligible articles showed that the top three symptoms were similar between women and men – limb weakness (72% vs. 66%), hemiparesis (56% vs. 55%), and weakness of the face, arm or leg (55% vs. 55%). However, the top 4th and 5th symptoms found in women were generalised non-specific weakness (49%) and motor deficit (46%), whereas in men these were motor deficit (46%) and ataxia (44%). In addition, crude RR showed that women were more likely to have higher risk than men of presenting with confusion (RR 1.16, CI 1.01-1.32), dysphagia (RR 1.29, CI 1.13-1.48), dysphasia (RR 1.11, CI 1.00-1.24), fatigue (RR 1.42, CI 1.05-1.92), generalised weakness (RR 1.56 CI 1.23-1.98), headache (RR 1.14, CI 1.01-1.30), urinary incontinence (RR 1.25, CI 1.17-1.33), loss of consciousness (RR 1.30, CI 1.12-1.51), and mental status change (RR 1.37, CI 1.18-1.58), and lower risk of presenting with dizziness (RR 0.87, CI 0.80-0.95), dysarthria (RR 0.89, CI 0.82-0.95), imbalance (RR 0.68, CI 0.57-0.81), paraesthesia (RR 0.74, CI 0.58-0.93), and trouble walking (RR 0.83, CI 0.70-0.99). Finally, pooled RR of delayed or missed diagnosis for women compared to men was not statistically significant (RR 1.19, CI 0.94-1.49).Conclusion:Though women and men commonly presented with similar symptoms, some sex differences were present which needs consideration in stroke evaluation.

Stroke, Volume 53, Issue Suppl_1, Page AWMP44-AWMP44, February 1, 2022. Introduction:Vagus nerve stimulation (VNS) is a surgical technique that has been used to modulate disease processes by activating the parasympathetic system and has been used to treat conditions such as epilepsy and depression. More recently, VNS has been a promising tool in ischemic stroke rehabilitation. However, there has been no literature summarizing the adverse effects of this procedure, information that is critical for both patients and providers when obtaining informed consent for this novel treatment. This systematic review and meta-analysis aims to report the adverse effects of VNS.Methods:A systematic review was performed in accordance with PRISMA guidelines in order to identify common complications after VNS therapy. The search was executed in three databases: Cochrane Central Register of Controlled Trials, Embase, and Ovid MEDLINE. All prospective, randomized controlled trials using implanted VNS therapy in adult patients were eligible for inclusion. Case studies and studies lacking complete complication reports were excluded. Extracted data included technology name, location of implantation, follow-up duration, purpose of VNS, and adverse event rates.Results:After title-and-abstract screening of 4933 studies identified by the created search strategy, 21 studies were selected for final inclusion. Included papers studied VNS as a potential therapy for epilepsy (9), depression (8), anxiety (1), ischemic stroke (1), chronic heart failure (1), and fibromyalgia (1). In total, 1474 patients received VNS implantation in the 21 studies. The 5 most common post-implant adverse events were voice alteration/hoarseness (n=671, 45.5%), paresthesia (n = 233, 15.8%), cough (n = 221, 15.0%), dyspnea (n = 211, 14.3%), and pain (n = 170, 11.5%).Conclusions:Complications from VNS are relatively mild and transient, with reduction in severity and number of adverse events with increasing follow-up time. The most common complications included voice changes or hoarseness, increased cough, and pain with swallowing after surgery. In summary, VNS presents a powerful tool for the treatment of many difficult-to-treat conditions. In the future, the use of VNS in recovery after intracerebral hemorrhage should be explored.

Stroke, Volume 53, Issue Suppl_1, Page AWMP4-AWMP4, February 1, 2022. Background and Purpose:Tenecteplase is being evaluated as an alternative intravenous (IV) thrombolytic agent for the treatment of acute ischemic stroke (AIS) within ongoing randomized controlled clinical trials. However, several research teams have published their real-world experience with tenecteplase for the treatment of AIS.Methods:We searched Medline and Scopus for non-randomized clinical trials and observational cohort studies (prospective or retrospective) comparing IV tenecteplase (at any dose) to IV alteplase for patients with AIS. We calculated the unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) for the association of tenecteplase vs. alteplase use and outcomes of interest. We pooled estimates using random-effects models. The primary outcome was the probability of modified Rankin scale (mRS) score of 0-2 at 90 days. Non-inferiority of tenecteplase vs. alteplase for the primary outcome in the meta-analysis was set at margins of 1.3% and 5% based on a recent survey.Results:We identified 6 studies comparing IV tenecteplase (n=583) to IV alteplase (n=904). Patients receiving tenecteplase had higher odds of successful recanalization (OR=2.82, 95%CI: 1.12, 7.11; adjusted OR=2.38, 95%CI: 1.18, 4.81) and early neurological improvement (OR=4.88, 95%CI: 2.03, 11.71; adjusted OR=7.60, 95%CI: 1.97, 29.41) when compared to alteplase. Tenecteplase was non-inferior (when applying the 5% non-inferiority margin) to alteplase for the primary outcome of mRS 0-2 at 90 days (absolute risk difference=0.06, 95%CI: -0.04, 0.15; OR=1.20, 95%CI: 0.86, 1.67; adjusted OR=1.24, 95%CI: 0.88, 1.76). No difference in the risk of symptomatic intracranial hemorrhage was uncovered between the two groups (OR=0.96, 95%CI: 0.45, 2.07; adjusted OR=0.92, 95%CI: 0.47, 1.81).Conclusion:Real world evidence suggests that tenecteplase has a comparable efficacy and safety profile to alteplase for the treatment of AIS, while being possibly superior in achieving successful reperfusion and early neurological improvement.

Stroke, Volume 53, Issue Suppl_1, Page AWP179-AWP179, February 1, 2022. Background and Purpose:Prolonged cardiac rhythm monitoring can reveal a substantial proportion of ischemic stroke (IS) patients with atrial fibrillation (AF). We sought to evaluate the potential utility of available prolonged cardiac rhythm monitoring strategies with respect to secondary stroke prevention.Methods:We searched Medline and Scopus databases to identify randomized controlled clinical trials (RCTs) comparing AF detection, anticoagulation initiation and stroke recurrence rates in patients with history of recent IS or transient ischemic attack (TIA) receiving cardiac rhythm monitoring with implantable loop recorders (ILRs), 30-days external loop recorders or Holter monitors. We performed a network meta-analysis to combine direct and indirect evidence for any given pair of monitoring devices that were evaluated within a trial and reported effect estimates with risk ratios (RRs) and corresponding 95% confidence intervals (95%CIs).Results:We identified 5 RCTs including a total of 2202 patients (mean age 68 years, 40% women). In indirect analyses the likelihood of AF detection and anticoagulation initiation was higher for both ILR (RR=8.48, 95%CI: 3.41, 21.06; RR=3.29, 95%CI: 1.70-6.39) and external loop recorders (RR=3.06, 95%CI: 1.66, 5.61; RR=1.63, 95%CI: 1.03-2.58) compared to Holter devices. The probability of AF detection and anticoagulation initiation was lower for Holter and external loop recorders compared to ILR devices (RR=0.36, 95%CI: 0.15, 0.85 and RR=0.50, 95%CI: 0.25-0.98, respectively). No difference in the risk of stroke recurrence was found in the indirect comparisons of different cardiac rhythm monitoring strategies.Conclusion:The likelihood of AF detection and anticoagulation initiation after an ischemic stroke or TIA is higher with ILRs compared to both external loop recorders and Holter devices.

Stroke, Volume 53, Issue Suppl_1, Page ATMP49-ATMP49, February 1, 2022. Objectives:Acute respiratory distress syndrome (ARDS) is a frequent complication seen in patients after aneurysmal subarachnoid hemorrhage (aSAH), but its prevalence, timing, and influence on neurological outcome is unclear. We aimed to investigate the prevalence, timing, risk factors, and outcome of ARDS in patients with aSAH.Methods:PubMed and four other databases (Embase, Cochrane Library, Web of Science Core Collection, and Scopus) from inception to July 6, 2020. We included all randomized controlled trials (RCTs) and observational studies of patients older than 18 years old. Two independent reviewers extracted the data. Study quality was assessed by the Cochrane Risk of Bias tool for RCTs, the Newcastle-Ottawa Scale for cohort and case-control studies. High-grade aSAH was defined as admission Glasgow coma scale 3-5 and/or modified fisher scale >=3 and/or Hunt Hess grade >=3. Good neurological outcome was defined as Glasgow Outcome Scale ≥ 4. Random-effects meta-analyses were conducted to estimate pooled outcome prevalence and their 95% confidence intervals (CI).Results:Nine observational studies (n=2,039) met the inclusion criteria, with the median age of 55 years (range=50-61, 28% male) and 71% patients suffered high-grade aSAH. Overall, 16% patients (95% CI=0.05-0.28, I2=94%) had ARDS after aSAH. The median time from SAH to ARDS was 3 days (range=2-6 days). Overall survival at discharge was 79% (95% CI=0.71-0.87; I2=95%) and good neurological outcome at any time was achieved in 65% of aSAH patients (95%CI=0.61-0.69; I2= 0.02%). aSAH cohort without ARDS had higher proportion of survival compared to those with ARDS (79% vs. 49%, p=0.028). Male sex, patients with high-grade aSAH, patients who developed pneumonia and systemic inflammatory response syndrome during hospital admission were at higher risk of developing ARDS.Conclusions:In this meta-analysis, approximately one in six patients developed ARDS after aSAH with the median time of 3 days from initial presentation and is associated with increased mortality. Further research to better understand the prevention and treatment strategy is necessary.

Stroke, Volume 53, Issue Suppl_1, Page AWP89-AWP89, February 1, 2022. Introduction:Enrollment of populations that bear the real-world burden of ischemic strokes is critical to development of generalizable and clinically relevant randomized clinical trials (RCTs). Despite well-recognized historical patterns of underrepresentation for women, older adults, and certain racial/ethnic minorities, major knowledge gaps remain regarding representation in modern trials. We aimed to determine representativeness by age, sex, and race/ethnicity of participants in acute ischemic stroke RCTs performed in the US or CanadaMethods:We conducted a systematic review and meta-analysis in accordance with PRISMA, and prospectively registered with PROSPERO (CRD42021247730). ClincalTrials.gov was searched for ischemic stroke RCTs with acute interventions (

Stroke, Volume 53, Issue Suppl_1, Page AWP209-AWP209, February 1, 2022. Background:The optimal timing for the initiation of anticoagulation in patients with acute ischemic stroke (AIS) related to atrial fibrillation (AF) remains uncertain. Observational studies assessing early anticoagulant initiation (≤14 days after index AIS) have provided conflicting results from the early use of non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs).Methods:We performed a meta-analysis of prospective observational studies and RCTs to assess the efficacy and safety of early anticoagulation in AF-related AIS. We also compared the efficacy and safety between NOAC and VKA regimens. A random-effects model was used to pool the individual risk ratios (RRs) and corresponding 95% confidence intervals (CIs) between the two groups. Recurrent ischemic stroke was defined as the primary outcome.Results:Nine eligible studies (7 observational, 2 RCTs) were identified, including 6,840 patients with AF-related AIS (pooled mean baseline NIHSS score: 5.5; 95%CI: 3.7-7.2) who received early anticoagulation. The overall ischemic stroke recurrence rate was 5% (95%CI: 3.3-7%) and differed (p=0.05) between studies reporting anticoagulation initiation within a week (2.5%, 95%CI: 0.2-7.4%) or two weeks (6.7%, 95%CI:4.6-9.1%) from index event. The corresponding proportions of patients experiencing a fatal outcome, symptomatic or asymptomatic ICH were 4% (95%CI: 1.6-7.5%), 1.2% (95%CI: 0.3-2.6%) and 13.2% (95%CI: 6.4-22.1%), respectively. Of the 2 identified RCTs, 136 and 135 patients were randomized to early anticoagulation with NOAC or VKA, respectively. Both groups had a similar risk for ischemic stroke recurrence (RR=0.78; 95%CI: 0.32, 1.91; p=0.59). No significant differences were uncovered between early NOAC or early VKA treatment initiation for the outcomes of mortality (RR=0.57; 95%CI: 0.11, 2.97; p=0.51), symptomatic ICH (RR=0.38; 95%CI: 0.02, 9.10; p=0.55) or asymptomatic ICH (RR=1.10; 95%CI: 0.73, 1.67; p=0.64).Conclusions:Preliminary evidence from RCTs on early anticoagulation after AF-related AIS suggest that NOACs have comparable efficacy to VKAs in preventing ischemic stroke recurrence. Large scale RCTs are warranted to evaluate the potential superiority of NOACs in terms of safety endpoints.

Stroke, Volume 53, Issue Suppl_1, Page AWP208-AWP208, February 1, 2022. Post-stroke cognitive impairment (PSCI) occurs in 20%-40% of stroke patients and was reported to be a risk factor of recurrent stroke and death. However, to date, no systematic review and meta-analysis exists to precisely estimate the associated risk. The goal of the current study was to conduct a systematic review of published literature on the association between PSCI and risk of recurrent stroke and death. We searched Ovid MEDLINE and Scopus for studies published from 1992 to 2019, combining the following keywords: post-stroke cognitive impairment, risk of stroke recurrence, mortality, post-stroke dementia. Of the 929 references, we identified 23 studies (n=28,305 patients) that met eligibility criteria. The time of PSCI diagnosis ranged from 7 days to 6 months, and 3-month after stroke was the most common time point of neuropsychological testing. The majority (65%, 15/23) of these studies evaluated PSCI mortality endpoint (n = 23,554), while 35% (8/23) looked at combined endpoint of recurrent stroke and death (n= 4,751). In mortality studies, 86% (13/15) showed significantly higher risk of death in PSCI patients compared to those without it (OR/HR/RR range from 1.42 to 7.42). In the two largest studies (n=8,822 and n=6,504), the adjusted HR were 1.42 (1.34-1.50) and RR 2.0 (1.3-3.2) respectively. Only 14% (2/15) of the studies showed negative results. However, one negative study [HR: 1.00 (0.79-1.86)] included a large cohort (n=3,948). In recurrence studies, 75% (6/8) reported higher risk with OR/HR/RR ranging from 1.48 to 4.86. Subgroup analyses in the two largest recurrence clinical trial studies (n=1,528 and n=1,240) reported HR 1.48 (1.04-2.09) and OR 2.32 (1.10-4.89). No association between PSCI and recurrent stroke was found in 25% (2/8) of recurrence studies including those with n=458 [HR 1.74 (0.89-3.39)] and n=202 patients [RR 1.25 (0.47-3.33)].This systematic review revealed about a 0.5 to 7 times increased risk of recurrent stroke and death in patients with PSCI suggesting that PSCI might be a marker predicting recurrent events in secondary stroke prevention. A meta-analysis is warranted to increase the precision and validity of risk estimates of PSCI and study the bases for differences across studies.

Stroke, Volume 53, Issue Suppl_1, Page AWP200-AWP200, February 1, 2022. Introduction:Delineating predictors of dementia among ischemic stroke survivors is critical to reduce dementia burden and to improve quality of life in this population.Methods:A Metaanalysis compliant with Preferred Reporting Items for Systematic Reviews and Metaanalysis was conducted. Analysis included absolute risk, incidence rates and patient level predictors (demographics, CVD history,TIA, stroke location, disability, chronic brain changes and stroke mechanism). Additional predictors included study setting, method of dementia diagnosis and inclusion of patients with recurrent or first ever stroke. A random effects meta-analysis was undertaken.Results:4,325 studies were screened and a total of 21 studies were included in metaanalysis, representing 55183 patients with ischemic stroke, with average age of 70 years (range 65-80 years) and average followup of 29 months. Overall rate of dementia after ischemic stroke was 13.0 per 1000 py (95% CI 6.0, 36.0). Incidence rates were eight times higher in hospital based studies (17.0, CI 8.0, 36.0) compared to registry-based studies (1.8, CI 0.8, 4.0). Absolute dementia risk after stroke was 20% at 5 year, 30 at 15 years and 48 at 25 years of follow-up. There was 33 difference in dementia incidence in the later study periods (2007-2009) compared to (1996-2006). Statistically significant predictors of dementia after ischemic stroke included female gender (OR 1.2, CI 1.1-1.4), hypertension (1.4 CI 1.1-2.0), diabetes mellitus (1.6 CI 1.3-2.1), atrial fibrillation (1.9 CI 1.2-3.0), previous stroke (2.0 CI 1.6-2.6), presence of stroke lesion in dominant hemisphere (2.4 CI 1.3-4.5), brain stem (0.5, CI 0.3-0.9) frontal lobe (3.7 CI 1.2-12.0), aphasia (7.9, CI 2.4-26.0), dysphasia (5.8 CI 3.0-11.3), gait impairment (1.7, CI 1.1-2.7), white matter hyperintensities (3.2 CI 2.0-5.3), medial temporal lobe atrophy (3.9 CI 1.9-8.3) and transient ischemic attack as the predisposing aetiology for ischemic stroke (0.44 CI 0.22-0.88).Conclusions:Factors routinely collected at time of admission are key in monitoring patients at highest risk of progression to dementia after acute ischemic stroke, in particular stroke location and presence of stroke related disability.

Stroke, Volume 53, Issue Suppl_1, Page ATP147-ATP147, February 1, 2022. Background and Purpose:Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic stroke (AIS) due to large vessel occlusion of the anterior circulation (AC-LVO). Randomized trials of posterior circulation large vessel occlusion (PC-LVO) patients have failed to show a benefit of EVT over medical therapy (MEDT). We performed a systematic review and meta-analysis to understand better whether EVT is beneficial for PC-LVO.Methods:Using the Nested Knowledge AutoLit living review platform, we identified randomized control trials and prospective studies that reported functional outcomes in patients with PC-LVO treated with EVT versus MEDT. The primary outcome variable was 90-day modified Rankin Scale (mRS) 0-3, and secondary outcome variables included 90-day mRS 0-2, 90-day mortality, and rate of symptomatic intracranial hemorrhage (sICH). A separate random effects model was fit for each outcome measure to calculate pooled odds ratios.Results:Three studies with 1,248 patients, 860 in the EVT arm and 388 in the MEDT arm, were included in the meta-analysis. The favorable outcome rate (mRS 0-3) in EVT patients was 39.9% (95% CI: 30.6-50.1%) versus 24.5% in MEDT patients (95% CI: 9.6-49.8%). EVT patients had higher mRS 0-2 rates (31.8% [95% CI: 25.7-38.5%] versus 19.7% [95% CI: 7.4-42.7%]) and lower mortality (42.1% [95% CI: 35.9-48.6%] versus 52.8% [95% CI: 33.3-71.5%]) compared to MEDT patients, but neither result was statistically significant. EVT patients were more likely to develop sICH (OR=10.36; 95% CI: 3.92-27.40).Conclusions:EVT treatment of PC-LVO trended toward superior functional outcomes and reduced mortality compared to MEDT despite a trend toward increased sICH in EVT patients. Existing randomized and prospective studies are insufficiently powered to demonstrate a benefit of EVT over MEDT in PC-LVO patients.

Stroke, Volume 53, Issue Suppl_1, Page AWP203-AWP203, February 1, 2022. Background and Purpose:To assess the effects of oral factor Xa inhibitors for prevention of ischemic stroke in patients without a history of atrial fibrillation.Methods:Systematic review of randomized clinical trials (RCTs) testing oral factor Xa inhibitors in patients without a history of atrial fibrillation that reported ischemic stroke.Results:Twenty-two RCTs reported 1194 ischemic strokes: five RCTs testing apixaban (75 ischemic strokes), one RCT each testing betrixaban (52 ischemic strokes) and edoxaban (1 ischemic stroke), and 15 RCTs testing rivaroxaban (1066 ischemic strokes). Three double-blinded RCTs reported statistically significant reductions in ischemic stroke: Two comparing rivaroxaban 2.5mg twice daily versus placebo in patients with cardiovascular disease (COMPASS, hazard ratio (HR) 0.51, 95%CI 0.38-0.68 and COMMANDER-HF, HR 0.64, 95%CI 0.43-0.95), and a third trial compared betrixaban 80mg daily with enoxaparin followed by placebo in patients hospitalized for acute medical illness (APEX, relative risk 0.53, 95%CI 0.30-0.94). Compared with aspirin, rivaroxaban 5mg twice daily significantly reduced ischemic stroke in patients with chronic atherosclerosis in COMPASS (HR 0.69, 95%CI 0.53-0.90), but in contrast rivaroxaban 15mg daily vs. aspirin showed no reduction in ischemic stroke in patients with recent embolic stroke in the large NAVIGATE ESUS trial (HR 1.01, 95%CI 0.81-1.26). Comparisons from 18 other RCTs were inconclusive, although trends consistently showed numerically fewer ischemic strokes among those assigned oral fXa inhibitors compared with placebo.Conclusions:There is convincing evidence that oral factor Xa inhibitors reduce ischemic stroke in patients without a history of atrial fibrillation. The strongest evidence was for rivaroxaban 2.5mg twice daily when given with aspirin in patients with cardiovascular disease. Reduction in ischemic stroke by other dosages, by other factor Xa inhibitors, and when given without antiplatelet agents is less certain. The contribution of atrial fibrillation-related stroke unlikely accounts for the observed reductions.