-
Frontiers in Neurology 2023The impact of COVID-19 on clinical outcomes in acute ischemic stroke patients receiving reperfusion therapy remains unclear. We therefore aimed to synthesize the... (Review)
Review
BACKGROUND
The impact of COVID-19 on clinical outcomes in acute ischemic stroke patients receiving reperfusion therapy remains unclear. We therefore aimed to synthesize the available evidence to investigate the safety and short-term efficacy of reperfusion therapy in this patient population.
METHODS
We searched the electronic databases MEDLINE, Embase and Cochrane Library Reviews for randomized controlled trials and observational studies that investigated the use of intravenous thrombolysis, endovascular therapy, or a combination of both in acute ischemic stroke patients with laboratory-confirmed COVID-19, compared to controls. Our primary safety outcomes included any intracerebral hemorrhage (ICH), symptomatic ICH and all-cause in-hospital mortality. Short-term favorable functional outcomes were assessed at discharge and at 3 months. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran's Q test and statistics.
RESULTS
We included 11 studies with a total of 477 COVID-19 positive and 8,092 COVID-19 negative ischemic stroke patients who underwent reperfusion therapy. COVID-19 positive patients exhibited a significantly higher risk of experiencing any ICH (RR 1.54, 95% CI 1.16-2.05, < 0.001), while the nominally increased risk of symptomatic ICH in these patients did not reach statistical significance (RR 2.04, 95% CI 0.97-4.31; = 0.06). COVID-19 positive stroke patients also had a significantly higher in-hospital mortality compared to COVID-19 negative stroke patients (RR 2.78, 95% CI 2.15-3.59, < 0.001). Moreover, COVID-19 positive stroke patients were less likely to achieve a favorable functional outcome at discharge (RR 0.66, 95% CI 0.51-0.86, < 0.001) compared to COVID-19 negative patients, but this difference was not observed at 3-month follow-up (RR 0.64, 95% CI 0.14-2.91, = 0.56).
CONCLUSION
COVID-19 appears to have an adverse impact on acute ischemic stroke patients who undergo reperfusion therapy, leading to an elevated risk of any ICH, higher mortality and lower likelihood of favorable functional outcome.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42022309785.
PubMed: 37681003
DOI: 10.3389/fneur.2023.1239953 -
Nigerian Journal of Clinical Practice Apr 2018This study reviews the oxygen therapy (normobaric oxygen [NBO] and hyperbaric oxygen [HBO]) in both stroke and traumatic brain injury (TBI) patients and meta-analyzes... (Meta-Analysis)
Meta-Analysis Review
This study reviews the oxygen therapy (normobaric oxygen [NBO] and hyperbaric oxygen [HBO]) in both stroke and traumatic brain injury (TBI) patients and meta-analyzes the efficacy of two oxygen therapies in different kinds of injuries. In stroke patients, NBO showed significant improvement in reperfusion rate while there is no favorable outcome effect of HBO treatment. In patients with TBI, HBO showed significant improvement of Glasgow outcome scale score and reduction of overall mortality while NBO may play a favorable role in improving brain metabolism.
Topics: Animals; Brain Injuries, Traumatic; Humans; Hyperbaric Oxygenation; Male; Neuroprotection; Neuroprotective Agents; Oxygen; Oxygen Inhalation Therapy; Stroke; Treatment Outcome
PubMed: 29607850
DOI: 10.4103/njcp.njcp_315_16 -
International Journal of Stroke :... Feb 2015Thirty percent of ischemic stroke (IS) patients suffering from acute stroke are under antiplatelet therapy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Thirty percent of ischemic stroke (IS) patients suffering from acute stroke are under antiplatelet therapy.
AIMS
We evaluated whether prior antiplatelet use before intravenous (IV), intra-arterial (IA) or combined IV/IA therapy may be associated with worse outcomes and an increased intracerebral hemorrhage (ICH) risk after reperfusion therapies.
METHODS
We analyzed data from our patient registry (n = 874) and conducted a systematic review of previous observational studies. The primary outcome was the percentage of patients who developed symptomatic ICH (sICH), defined in our registry per ECASS-II definition.
RESULTS
We identified 43 previous reports that evaluated the impact of prior antiplatelet use on outcomes after reperfusion therapy in AIS patients. Prior antiplatelet use was found in 35% of AIS patients, eligible for reperfusion therapies and was associated with a worse vascular profile. In an unadjusted meta-analysis that included our registry data, prior antiplatelet use was associated with more sICH per ECASS-II definition (OR, 1.78 (95% CI, 1.48-2.13), and less favorable outcome (OR, 0.86; 95% CI, 0.77-0.98). However, in multivariate analyses conducted in our registry showed that prior antiplatelet use was not associated with worse outcome (P > 0.23); and in the systematic review, only 3 studies reported a slight, but significant adjusted increase in sICH risk, of whom one had conflicting results according to sICH definition.
CONCLUSIONS
These results suggest no significant detrimental effect of prior antiplatelet use in AIS patients treated by IV, IA or combined IV/IA therapy. Further studies are needed to assess the specific impact of different and cumulative antiplatelet agents.
Topics: Aged; Cerebral Hemorrhage; Female; Humans; Male; Platelet Aggregation Inhibitors; Registries; Stroke; Thrombolytic Therapy; Treatment Outcome
PubMed: 25487908
DOI: 10.1111/ijs.12421 -
International Journal of Stroke :... Dec 2023Endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) have an unclear benefit in those with pre-stroke dementia or cognitive impairment, as these patients... (Review)
Review
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.
PubMed: 38044328
DOI: 10.1177/17474930231220186 -
The Journal of Invasive Cardiology Nov 2014To correlate early and late mortality with markers of reperfusion in ST-elevation myocardial infarction (STEMI). (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To correlate early and late mortality with markers of reperfusion in ST-elevation myocardial infarction (STEMI).
BACKGROUND
Early reperfusion improves STEMI outcomes. Reperfusion can be assessed using angiographic (Thrombolysis in Myocardial Infarction [TIMI] flow grade or myocardial blush grade [MBG]) or electrocardiographic markers (ST-segment recovery (STR).
METHODS
We searched electronic databases for all STEMI randomized clinical studies from the last decade reporting markers of reperfusion and clinical outcome. We used a generalized estimating equation (GEE) model with logistic regression link in order to assess the correlation between each marker of reperfusion and mortality at 30 and 365 days. We also performed random effect meta-analysis for selected studies comparing mortality for specific categories of MBG.
RESULTS
We identified 44 studies with 19,955 patients. Final TIMI 3 flow was achieved in 87%, 70% had MBG 2 or 3, and 66% had complete STR. Average 30-day and 1-year mortality was 2.97 ± 2.34% and 4.11 ± 2.52%, respectively. Adjusting (study level) for age, diabetes, chronic kidney disease, infarct location, ejection fraction, and female sex, there was significant correlation between each of the three markers and 1-year mortality (P=.03 for TIMI 3; P=.02 for MBG 2 or 3; and P=.04 for STR). In nearly 6000 patients, there was substantial excess mortality in those with MBG 0/1 compared with MBG 2/3 (relative risk = 2.14 [1.65-2.77] with P<.001 at 30 days; relative risk = 1.49 [1.3-1.7] and P<.001 at 1 year).
CONCLUSION
After correcting for clinical factors known to affect outcome, there was a significant correlation between survival and better reperfusion.
Topics: Coronary Circulation; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Myocardial Infarction; Myocardial Reperfusion; Prognosis; Randomized Controlled Trials as Topic; Statistics as Topic; Stroke Volume; Survival Analysis; Thrombolytic Therapy
PubMed: 25364000
DOI: No ID Found -
Future Cardiology Nov 2017A systematic review and meta-analysis, evaluating ischemic conditioning during percutaneous coronary intervention (PCI). (Meta-Analysis)
Meta-Analysis Review
AIM
A systematic review and meta-analysis, evaluating ischemic conditioning during percutaneous coronary intervention (PCI).
METHODS & RESULTS
A database search of randomized trials of ischemic conditioning in PCI created three subgroups for meta-analysis: mortality in elective PCI with remote ischemic preconditioning (RIPreC; subgroup 1a, n = 3) - no outcome difference between RIPreC and control (odds ratio: 0.34; 95% CI: 0.08-1.56), myocardial salvage index in ST-elevation myocardial infarction (STEMI) with RIPreC (subgroup 1b, n = 2) - favored RIPreC (mean difference: 0.13; 95% CI: 0.07-0.19), and infarct size in STEMI with local ischemic postconditioning (LIPostC) (subgroup 4b, n = 12) - favored LIPostC (mean difference: -4.13 g.m; 95% CI: -7.36 to -0.90 g.m).
CONCLUSION
RIPreC and LIPostC improve myocardial salvage index and myocardial infarct size respectively in PCI for STEMI. No mortality benefit detected with RIPreC in elective PCI.
Topics: Cardiac Catheterization; Coronary Angiography; Elective Surgical Procedures; Electrocardiography; Emergency Treatment; Female; Humans; Ischemic Postconditioning; Ischemic Preconditioning, Myocardial; Male; Monitoring, Intraoperative; Percutaneous Coronary Intervention; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; ST Elevation Myocardial Infarction; Survival Analysis; Treatment Outcome
PubMed: 29076346
DOI: 10.2217/fca-2017-0042 -
Frontiers in Neurology 2022Clinical trials of neuroprotection in acute ischemic stroke (AIS) have provided disappointing results. Reperfusion may be a necessary condition for positive effects of...
BACKGROUND
Clinical trials of neuroprotection in acute ischemic stroke (AIS) have provided disappointing results. Reperfusion may be a necessary condition for positive effects of neuroprotective treatments. This systematic review provides an overview of efficacy of neuroprotective agents in combination with reperfusion therapy in AIS.
METHODS
A literature search was performed on the following databases, namely PubMed, Embase, Web of Science, Cochrane Library, Emcare. All databases were searched up to September 23rd 2021. All randomized controlled trials in which patients were treated with neuroprotective strategies within 12 h of stroke onset in combination with intravenous thrombolysis (IVT), endovascular therapy (EVT), or both were included.
RESULTS
We screened 1,764 titles/abstracts and included 30 full reports of unique studies with a total of 16,160 patients. In 15 studies neuroprotectants were tested for clinical efficacy, where all patients had to receive reperfusion therapies, either IVT and/or EVT. Heterogeneity in reported outcome measures was observed. Treatment was associated with improved clinical outcome for: 1) uric acid in patients treated with EVT and IVT, 2) nerinetide in patients who underwent EVT without IVT, 3) imatinib in stroke patients treated with IVT with or without EVT, 4) remote ischemic perconditioning and IVT, and 5) high-flow normobaric oxygen treatment after EVT, with or without IVT.
CONCLUSION
Studies specifically testing effects of neuroprotective agents in addition to IVT and/or EVT are scarce. Future neuroprotection studies should report standardized functional outcome measures and combine neuroprotective agents with reperfusion therapies in AIS or aim to include prespecified subgroup analyses for treatment with IVT and/or EVT.
PubMed: 35370911
DOI: 10.3389/fneur.2022.840892 -
Acta Neurologica Scandinavica Apr 2021Computed tomography perfusion (CTP) imaging could be useful in guiding reperfusion therapy or patient selection in acute ischemic stroke (AIS) patients. The aim of the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Computed tomography perfusion (CTP) imaging could be useful in guiding reperfusion therapy or patient selection in acute ischemic stroke (AIS) patients. The aim of the current study was to determine the efficacy of the CTP-guided reperfusion therapy in AIS by performing a systematic review and meta-analysis.
METHODS
Medline/PubMed, Embase, and the Cochrane library were searched using the terms: "CT perfusion", "acute stroke" and "reperfusion therapy". The following studies were included: (a) studies reporting original data; (b) patients aged 18 years or above; (c) patients diagnosed with anterior circulation AIS; and (d) studies with good methodological design.
RESULTS
Twenty-two studies were finally included in the metanalysis with a total of 5, 687 patients. CTP-guided reperfusion therapy was associated with increased odds of good functional outcome without significant difference in safety profile.
CONCLUSIONS
CTP-guided reperfusion therapy improved functional outcomes in AIS, with increased benefits to patients treated with endovascular thrombectomy.
Topics: Adolescent; Aged; Brain Ischemia; Female; Humans; Ischemic Stroke; Male; Middle Aged; Randomized Controlled Trials as Topic; Reperfusion; Thrombectomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33188539
DOI: 10.1111/ane.13374 -
Journal of Clinical and Translational... Jun 2022Lymph node transfer surgery (LNTS) is indicated in secondary lymphedema (LE) patients who do not respond to conservative therapy. Animal models are the spearhead of LE... (Review)
Review
BACKGROUND AND AIM
Lymph node transfer surgery (LNTS) is indicated in secondary lymphedema (LE) patients who do not respond to conservative therapy. Animal models are the spearhead of LE research and were used to pioneer most of the surgical interventions currently in practice. We conducted a systematic review of the literature to explore animal models dedicated to LNTS to compare different species, techniques, and outcomes.
METHODS
Four databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization.
RESULTS
Avascular lymph node graft (ALNG) and vascularized lymph node transfer (VLNT) effectively treated LE and lead to better outcomes than controls. Whole ALNGs are superior to fragmented ALNGs. Larger fragments are more likely to be reintegrated into the lymphatic system than small fragments. VLNT was superior to whole and fragmented ALNG. Increasing the number of VLNT resulted in better outcomes. Adipose-derived stem cells improved outcomes of VLNT; vascular endothelial growth factor C and D and platelet-rich plasma improved outcomes for ALNG. Cryopreservation of lymph nodes (LNs) did not affect outcomes for ALNG. The critical ischemia and venous occlusion time for LN flaps were 4-5 and 4 h, respectively. The critical time for reperfusion injury was 2 h. Some of the novel models included venous LNT, and cervical adipocutaneous flap to groin.
CONCLUSION
Current evidence from animals favors VLNT over other surgical interventions. Several pharmacological therapies significantly improved outcomes of ALNG and VLNT.
RELEVANCE TO PATIENTS
LE is a chronic condition affecting millions of patients worldwide. LNTS is becoming more popular as a LE treatment. Animal models have led the LE research for decades and developing new models for LE are essential for LE research. This systematic review aims to summarize the existing animal models dedicated to LNTS. We believe that this review is critical to guide researchers in the selection of the model that is best fit for their hypothesis-driven experiments.
PubMed: 35813893
DOI: No ID Found -
Free Radical Biology & Medicine Aug 2021Although myocardial ischemia-reperfusion injury (I/R) and its pathological consequences are the leading cause of morbidity and mortality worldwide, cardioprotective... (Review)
Review
Systematic review and network analysis of microRNAs involved in cardioprotection against myocardial ischemia/reperfusion injury and infarction: Involvement of redox signalling.
Although myocardial ischemia-reperfusion injury (I/R) and its pathological consequences are the leading cause of morbidity and mortality worldwide, cardioprotective therapeutics are still not on the market. Oxidative stress, a major contributing factor to myocardial I/R, changes transcription of coding and non-coding RNAs, alters post-transcriptional modulations, and regulate protein function. MicroRNA (miRNA) expression can be altered by oxidative stress and microRNAs may also regulate cytoprotective mechanisms and exert cardioprotection againts I/R. Transcriptomic analysis of I/R and oxidative stress-induced alterations followed by microRNA-mRNA target interaction network analysis may reveal microRNAs and their mRNA targets that may play a role in cardioprotection and serve as microRNA therapeutics or novel molecular targets for further drug development. Here we provide a summary of a systematic literature review and in silico molecular network analysis to reveal important cardioprotective microRNAs and their molecular targets that may provide cardioprotection via regulation of redox signalling.
Topics: Humans; Infarction; MicroRNAs; Myocardial Reperfusion Injury; Oxidation-Reduction; Signal Transduction
PubMed: 33965565
DOI: 10.1016/j.freeradbiomed.2021.04.034