AI Article Synopsis
- Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) were analyzed for their effectiveness in patients with pre-stroke dementia or cognitive impairment, a group often excluded from clinical trials.
- A systematic review and meta-analysis included nine studies, showing no significant differences in 90-day outcomes, mortality, or intracranial hemorrhage between those with and without pre-stroke dementia receiving IVT.
- The findings suggest that while IVT and EVT have no major safety concerns for these patients, pre-stroke cognitive impairment may lead to poorer 90-day outcomes specifically with EVT.
Article Abstract
Background: Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) have an unclear benefit in those with pre-stroke dementia or cognitive impairment, as these patients were often excluded from landmark stroke trials. We performed a systematic review and meta-analysis to assess the outcomes of IVT and EVT in these populations.
Aims: Our systematic review, conforming to the Meta-Analysis of Observational Studies in Epidemiology guidelines, investigated studies on acute ischemic stroke patients with pre-stroke dementia or cognitive impairment treated with IVT or EVT. Primary outcome was favorable 90-day outcome (mRS 0-2). Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (SICH), and radiographic intracranial hemorrhage (ICH).
Summary Of Review: Nine articles were identified, with five observational studies of IVT use in patients with (n = 1078) and without dementia (n = 2805) being selected for the meta-analysis. There were no significant differences in favorable outcome (adjusted OR: 0.61, 95% CI 0.24-1.59), mortality (unadjusted OR: 1.19, 95% CI 0.86-1.64), ICH (unadjusted OR: 1.32, 95% CI 0.79-2.19), and symptomatic ICH (unadjusted OR: 0.94, 95% CI 0.70-1.25) for patients undergoing IVT with pre-stroke dementia versus those without. One EVT study (n = 615 with dementia vs n = 9600 without) found no significant differences in outcomes apart from an increased odds of ICH for those with pre-existing dementia (adjusted OR: 1.57, 95% CI 1.03-2.40). A pooled analysis of three IVT studies showed no significant association of cognitive impairment (n = 93 vs n = 211 without) with all assessed outcomes, whereas a study of EVT found that pre-stroke cognitive impairment was associated with poor 90-day outcomes (mRS 3-6).
Conclusion: These results suggest no substantial safety issues in the use of IVT or EVT for patients with pre-existing dementia or cognitive impairment compared to those without. However, the efficacy of these therapies in this demographic remains uncertain. Further rigorous studies that include a more nuanced outcome measurement approach are warranted.
Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021240499.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409564 | PMC |
| http://dx.doi.org/10.1177/17474930231220186 | DOI Listing |
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