Abstract
BACKGROUND: Patients with acute stroke presenting with large vessel occlusion secondary to intracranial atherosclerosis (ICAS-LVO) may require rescue therapy (RT) in addition to mechanical thrombectomy to achieve and maintain successful recanalization. We performed a systematic review and meta-analysis of comparative studies that reported outcomes of RT in patients with ICAS-LVO to evaluate its safety and efficacy. METHODS: Databases searched include PubMed, CINAHL Complete, and Scopus from database date of inception through August 17, 2021. We included comparative studies that reported the outcomes of ICAS-LVO RT compared with outcomes of patients with ICAS-LVO who did not undergo RT or to those patients presenting with embolic large vessel occlusion (non-ICAS-LVO). Meta-analysis using the random-effects model was used to combine estimates reporting odds ratios (ORs) and 95% CIs. RESULTS: A total of 9 nonrandomized studies were included: 5 studies in ICAS-LVO RT versus ICAS-LVO non-RT analysis and 5 in ICAS-LVO RT versus non-ICAS LVO analysis. Rescue treatments included intra-arterial antiplatelets, angioplasty, stenting, or a combination of treatments. Compared with non-RT ICAS-LVO, RT was associated with an increased favorable 90-day outcome (OR, 3.19 [95% CI, 1.91-5.32]; I (2) = 14%) and decreased 90-day mortality (OR, 0.35 [95% CI, 0.16-0.76]; I (2) = 21%). In the analysis of ICAS-LVO RT versus embolic LV, the incidence of favorable 90-day outcome and 90-day mortality did not differ between ICAS-LVO RT and non-ICAS-LVO (OR, 0.97 [95% CI, 0.58-1.64; I (2) = 50%]; and OR, 1.22 [95% CI, 0.90-1.66; I (2) = 0%], respectively). CONCLUSIONS: Rescue treatment is likely associated with better outcomes in patients with ICAS-LVO. The outcomes of patients with ICAS-LVO who receive RT may be comparable with patients with embolic large vessel occlusion (non-ICAS-LVO).