Impact of hyperlipidemia and atrial fibrillation on the efficacy of endovascular treatment for acute ischemic stroke: a meta-analysis

INTRODUCTION: Stroke is the crucial cause of death annually. Inconsistent results from the randomized controlled trials (RCTs) aroused controversy on efficacy of endovascular treatment (EVT). MATERIALS AND METHODS: To evaluate the efficacy of EVT in stroke patients. We searched three databases including PubMed, Web of science and the Cochrane Library from Jan 2011 to Apr 2017. Eligible studies were RCTs comparing EVT versus standard medical therapy alone. The primary outcomes were favorable functional outcomes (modified Rankin Scale score, 0–2) at 3 months. Meta regression analysis and subgroup analysis were used to explore potential influence factors responsible for the effectiveness of EVT. RESULTS: Eleven RCTs involving 3018 patients were included in our study. EVT showed better functional outcomes at 90 days (OR, 1.71; 95% CI, 1.28–2.28; P < 0.001) and a higher recanalization rate at 24h (OR, 6.49; 95% CI, 4.79–8.79; P < 0.001). In meta-regression and subgroup analysis, primary outcomes were significantly better among patients with atrial fibrillation (Adj R-squared 46.30%, P = 0.054; OR, 2.40; 95% CI, 1.81–3.19; P < 0.001), patients without hyperlipidemia (Adj R-squared 35.21%, P = 0.159; OR, 2.34; 95% CI, 1.80–3.04; P < 0.001) and when new generation thrombectomy device was used (Adj R-squared 72.21%, P = 0.011; OR, 2.14; 95% CI, 1.75–2.61; P < 0.001). CONCLUSIONS: EVT showed superior clinical outcomes compared with standard medical therapy. The rate of using new generation thrombectomy device was the critical factor influencing therapeutic outcome. Hyperlipidemia and atrial fibrillation may also cause the potential effect.