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Endovascular treatment achieves better outcomes than best medical management in patients with M2 occlusion and high stroke severity: a meta-analysis

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Abstract

Background

The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for patients with M2 occlusion. This study aims to compare the efficacy and safety of endovascular treatment (EVT) with best medical management (BMM) in patients with M2 occlusion, and to investigate whether the optimal treatment varies according to stroke severity.

Methods

Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT and BMM. According to stroke severity, the study population were classified into those with moderate-severe stroke and those with mild stroke. National Institute of Health Stroke Scale (NIHSS) scores ≥ 6 was defined as moderate-severe stroke, and NIHSS scores 0–5 as mild stroke. Random-effects meta-analyses were performed to measure the symptomatic intracranial hemorrhage (sICH) within 72 h, and the modified Rankin Scale (mRS) scores 0–2 and the mortality at 90 days.

Results

Totally, 20 studies were identified, including 4358 patients. In the moderate-severe stroke population, the EVT had 82% higher odds for mRS scores 0–2 (OR 1.82, 95% CI 1.34–2.49) and a 43% lower odds for mortality (OR 0.57, 95% CI 0.39–0.82) compared with the BMM. However, no difference was found in the sICH rate (OR 0.88, 95% CI 0.44–1.77). In the mild stroke population, no differences were observed in the mRS scores 0–2 (OR 0.81, 95% CI 0.59–1.10) or mortality (OR 1.23, 95% CI 0.72–2.10) between EVT and BMM, whereas EVT was associated with higher sICH rate (OR 4.21, 95% CI 1.86–9.49).

Conclusion

EVT may be only beneficial for patients with M2 occlusion and high stroke severity, but not for those with NIHSS scores 0–5.

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Data availability

The clinical data used in this study can be provided via the corresponding authors upon reasonable request.

Abbreviations

AHA/ASA:

American Heart Association/American Stroke Association

BMM:

Best medical management

CI:

Confidence interval

EVT:

Endovascular treatment

sICH:

Symptomatic intracranial hemorrhage

MCA:

Middle cerebral artery

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Stroke Scale

OR:

Odds ratio

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Acknowledgements

This study was supported by grants from the National Natural Science Foundation of China (no. 82172603), the Natural Science Foundation of Jiangsu Province (no. BK20190241), and the Scientific Research Project of Jiangsu Provincial Health Commission (H2018064).

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  1. Yu Guo, Hao Wu, and Tian-yi Zhang contributed equally and shared first authorship.

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, 225009, Jiangsu, China

    Yu Guo, Yu-ping Li & Heng-zhu Zhang

  2. Graduate School, Dalian Medical University, Dalian, 116044, Liaoning, China

    Hao Wu

  3. School of Life Sciences, Nanjing University, Nanjing, 210008, Jiangsu, China

    Tian-yi Zhang & Yi-qiao Hu

  4. Department of Neurosurgery, Qinghai Provincial People’s Hospital, Xining, 810007, Qinghai, China

    Jin-cai Yang & Ming-fei Yang

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Contributions

YG, HW, and TYZ: the conception and design of the study, acquisition of data, analysis and interpretation of data, and drafting the article. YPL and JCY: revising it critically for important intellectual content. MFY, YQH, and HZZ: the conception and design of the study and revising it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ming-fei Yang, Yi-qiao Hu or Heng-zhu Zhang.

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Guo, Y., Wu, H., Zhang, Ty. et al. Endovascular treatment achieves better outcomes than best medical management in patients with M2 occlusion and high stroke severity: a meta-analysis. J Neurol 270, 2924–2937 (2023). https://doi.org/10.1007/s00415-023-11653-x

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