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Lookup NU author(s): Professor Phil White
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Background and Purpose- There is contradictory evidence on the impact of the stroke side (hemisphere) on outcomes. We investigated any effect modification by laterality on stroke patients' outcomes in recent endovascular trials. Methods- Individual patient-level data were combined in this meta-analysis of all patients included in randomized trials comparing endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischemic patients with stroke (HERMES [Highly Effective Reperfusion Using Multiple Endovascular Devices] Collaboration). We stratified the 90-day functional outcome assessed by ordinal analysis of the modified Rankin Scale according to the stroke side of patients treated with endovascular therapy versus standard care, adjusted for important prognostic variables. Results- The meta-analysis included 1737 patients (871 right hemispheric strokes and 866 left hemispheric) from 7 trials. Baseline median National Institutes of Health Stroke Scale scores were significantly higher in left (20) versus right (16) hemispheric strokes (P<0.001). Other clinical and radiological baseline characteristics were similar. The beneficial response to endovascular therapy assessed by 90-day modified Rankin Scale shift was not modified by the side of the stroke. There were no significant differences between right and left hemispheric stroke in the 90-day functional outcome (modified Rankin Scale score ≤2; 40.7% [95% CI, 37.4%-44.1%] versus 37.6% [95% CI, 37.4%-44.1%]; P=0.19), median final infarct volumes (45 versus 39.5 mL, P=0.51), nor 90-day mortality (15.1% vs 16.8%, P=0.31). Conclusions- Stroke side was not a prognostic factor and did not modify the treatment effect among patients treated in the endovascular or control groups in recent endovascular thrombectomy trials.
Author(s): Almekhlafi MA, Hill MD, Roos YM, Campbell BCV, Muir KW, Demchuk AM, Bracard S, Gomis M, Guillemin F, Jovin TG, Menon BK, Mitchell P, White P, van der Lugt A, Saver J, Brown S, Goyal M
Publication type: Article
Publication status: Published
Online publication date: 05/07/2019
Acceptance date: 13/05/2019
ISSN (print): 0039-2499
ISSN (electronic): 1524-4628
Publisher: American Heart Association
PubMed id: 31272328
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