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Neurology
Original research
Contrast extravasation and outcome of endovascular therapy in acute ischaemic stroke: a systematic review and meta-analysis
  1. Tao Xu,
  2. You Wang,
  3. Jinxian Yuan,
  4. Yangmei Chen,
  5. Haiyan Luo
  1. Department of Neurology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
  1. Correspondence to Haiyan Luo; haiyanl{at}hospital.cqmu.edu.cn

Abstract

Objective Contrast extravasation (CE) after endovascular therapy (EVT) is commonly present in acute ischaemic stroke (AIS) patients. Substantial uncertainties remain about the relationship between CE and the outcomes of EVT in patients with AIS. Therefore, we aimed to evaluate this association.

Design A systematic review and meta-analysis of published studies were performed.

Data source We systematically searched the Medline and Embase databases for relevant clinical studies. The last literature search in databases was performed in June 2020.

Eligibility criteria for study selection We included studies exploring the associations between CE and the outcomes of EVT in patients with AIS undergoing EVT.

Data extraction and synthesis Two reviewers extracted relevant information and data from each article independently. We pooled ORs with CIs using a random-effects meta-analysis to calculate the associations between CE and outcomes of EVT. The magnitude of heterogeneity between estimates was quantified with the I2 statistic with 95% CIs.

Results Fifteen observational studies that enrolled 1897 patients were included. Patients with CE had higher risks of poor functional outcome at discharge (2.38, 95% CI 1.45 to 3.89 p=0.001; n=545) and poor functional outcome at 90 days (OR 2.16, 95% CI 1.20 to 3.90; n=1194). We found no association between CE and in-hospital mortality (OR 0.95, 95% CI 0.27 to 3.30; n=376) or 90-day mortality (OR 1.38, 95% CI 0.81 to 2.36; n=697) after EVT. Moreover, CE was associated with higher risks of post-EVT intracranial haemorrhage (ICH) (OR 6.68, 95% CI 3.51 to 12.70; n=1721) and symptomatic ICH (OR 3.26, 95% CI 1.97 to 5.40; n=1092).

Conclusions This systematic review and meta-analysis indicates that in patients with AIS undergoing EVT, CE is associated with higher risks of unfavourable functional outcomes and ICH. Thus, we should pay more attention to CE in patients with AIS undergoing EVT.

  • stroke medicine
  • neuroradiology
  • stroke
  • interventional radiology

Data availability statement

Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-044917

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    Data availability statement

    Data are available on reasonable request. The data that support the findings of this study are available from the corresponding author.

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    Footnotes

    • Contributors HL and YC performed study design; TX and YW performed literature search and selection; TX and JY data acquisition, analysis and interpretation; TX and YW performed statistical analysis; TX and HL drafting of the manuscript.

    • Funding This study was supported by the National Science Foundation of China (No. 81901315 and No. 81771390) and also supported by the Kuanren Talents Program of the Second Affiliated Hospital of Chongqing Medical University (No.kryc-yq-2123), China.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.