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Mechanical Thrombectomy in Nonagenarians: a Systematic Review and Meta-analysis

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Abstract

This systematic review and meta-analysis aimed to summarize the current literature on mechanical thrombectomy (MT) in nonagenarians and to provide updated clinical evidence of its feasibility, effectiveness, and safety in nonagenarians. PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant randomized controlled trials and observational studies that reported the clinical outcomes of nonagenarians with acute ischemic stroke after undergoing mechanical thrombectomy. Risk of bias was assessed using different scales. I2 statistic was used to evaluate the heterogeneity of the results, while meta-regression and sensitivity analyses were performed to investigate the source of heterogeneity. Thirteen studies and 657 patients were included. The estimated rate of successful revascularization was 80.82% (95% confidence interval [CI]: 77.48–83.97%), and the rate of favorable outcome (modified Rankin score [mRS] 0–2) was 21.60% (95% CI: 13.81–30.41%). The rate of good outcome (mRS score 0–3) was 23.08% (95% CI: 18.88–27.55%). The estimated risk of death during hospitalization was 20.55% (95% CI: 15.93–25.55%), while the mortality rate at 3 months was 44.38% (95% CI: 33.66–55.36%). The rate of intracranial hemorrhage (ICH) occurrence was 12.84% (95% CI: 5.27–22.68%), while the rate of symptomatic intracranial hemorrhage (sICH) was 3.52% (95% CI: 1.67–5.85%). The rate of hospital-related complications was 26.93% (95% CI: 10.53–47.03%). MT in nonagenarians demonstrated a high rate of successful revascularization. Conversely, the rate of futile revascularization is high with a low functional independence proportion. Therefore, MT should not be indiscriminately advocated in nonagenarians. Satisfactory results require careful selection of patients. Further high-quality studies are needed to clarify the selection algorithm.

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Acknowledgment

We would like to thank Editage (www.editage.cn) for English language editing.

Funding

This work was supported by the National Key Research and Development Project (grant number 2016YFC1301703) and the Beijing Scientific and Technologic Project (grant number Z201100005520019). The funders have no role in study design, data analysis, and writing for manuscript.

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Author notes

  1. Xuesong Bai, Xiao Zhang and Yanhong Zhang contributed equally to this work.

Authors and Affiliations

  1. China International Neuroscience Institute (China-INI), Beijing, China

    Xuesong Bai, Xiao Zhang, Tao Wang, Yao Feng, Yan Ma & Liqun Jiao

  2. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Xuesong Bai, Xiao Zhang, Tao Wang, Yao Feng, Yan Ma & Liqun Jiao

  3. Medical Administration Division, Xuanwu Hospital, Capital Medical University, Beijing, China

    Yanhong Zhang

  4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, USA

    Wuyang Yang

  5. China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, China

    Yan Wang

  6. Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China

    Kun Yang

  7. Medical Library, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing, China

    Xue Wang

  8. Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China

    Liqun Jiao

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  1. Xuesong Bai
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Contributions

XB, XZ, YZ, and LJ developed the initial idea for this study. TW, XZ, YF, YW, XW, and KY developed and revised the search strategy. XB, XZ, YZ, WY, YM, and LJ formulated the study design. LJ and YM were consulted about clinical issues. XB and XZ contributed to the original draft. XB, XZ, WY, YZ, TW, KY, YM, and LJ were responsible for the revision of the draft. XB, XZ, and YZ contributed equally and are co-first authors. All authors approved the final version of the manuscript before submission.

Corresponding authors

Correspondence to Yan Ma or Liqun Jiao.

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Bai, X., Zhang, X., Zhang, Y. et al. Mechanical Thrombectomy in Nonagenarians: a Systematic Review and Meta-analysis. Transl. Stroke Res. 12, 394–405 (2021). https://doi.org/10.1007/s12975-021-00894-5

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