Abstract
Background
Mechanical Thrombectomy (MT) has improved outcomes in acute ischemic stroke (AIS) due to Large Vessel Obstruction (LVO). However, there is limited data on the safety and outcomes of MT in AIS patients with thrombocytopenia. This study aims to assess the efficacy and safety of MT in this population.
Methods
Following the PRISMA guidelines, a comprehensive systematic review was conducted using PubMed, Embase, Web of Science, and Scopus. Studies meeting inclusion criteria underwent rigorous risk of bias assessment using the ROBINS-I tool. We compared outcomes between patients with and without thrombocytopenia undergoing MT. Using the R software version 4.3.1, meta-analyses were conducted employing random-effect models.
Results
This meta-analysis encompassed data from 5 studies. Thrombocytopenic AIS patients who underwent MT (n = 974) exhibited lower rates of functional independence (OR 0.83, 95% CI 0.71–0.98; p = 0.030) compared to patients with normal platelet counts (n = 2036). In addition, the thrombocytopenic group experienced higher mortality as compared to the group with normal platelet counts (OR 1.76, 95% CI 1.26–2.45; p < 0.001). Rates of sICH were found to be similar between groups (OR 1.20, 95% CI 0.74–1.93; p = 0.456), as were rates of successful recanalization (OR 0.94, 95% CI 0.47–1.87; p = 0.863). Lastly, no significant differences were observed in procedure times between thrombocytopenic and non-thrombocytopenic groups.
Conclusion
As compared to patients without thrombocytopenia, thrombocytopenic AIS patients undergoing MT displayed lower functional independence and higher mortality rates, with no significant differences in sICH or successful recanalization.
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R.K. has the following conflicts: Research support from: Cerenovus Inc, Medtronic, Endovascular Engineering, Frontior Bio, Sensome Inc, Endomimetics, Ancure LLC, Neurogami Medical, MIVI Biosciences, Monarch Biosciences, Stryker Inc, Conway Medical, Pireus Medical, and Bionau Labs outside the submitted work. He holds the following research grants Research Grants: NIH (R01NS076491, R44NS107111, R43NS110114 and R21NS128199) and NSF (081215707) outside the submitted work. AAR serving on advisory boards for AstraZeneca, Novo Nordisk, and Boston Scientific outside the submitted work. D.F.K. holds equity in Nested Knowledge, Superior Medical Editors, and Conway Medical, Marblehead Medical and Piraeus Medical. He receives grant support from MicroVention, Medtronic, Balt, and Insera Therapeutics; has served on the Data Safety Monitoring Board for Vesalio; and received royalties from Medtronicoutside the submitted work.
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Toruno, M.A., Al-Janabi, O.M., Ghozy, S. et al. Outcomes of mechanical thrombectomy in patients with acute ischemic stroke and thrombocytopenia: systematic review and meta-analysis. J Neurol (2024). https://doi.org/10.1007/s00415-024-12363-8
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DOI: https://doi.org/10.1007/s00415-024-12363-8