A Meta‐Analysis of the Association Between Early Venous Filling and Hemorrhagic Transformation After Endovascular Treatment in Acute Large Vessel Occlusion

TL;DR

This study finds that early venous filling after stroke treatment is linked to higher bleeding risks and worse outcomes, suggesting the need for adjusted treatment strategies.

Contribution

The study provides a meta-analysis showing a strong association between early venous filling and increased hemorrhagic transformation after stroke treatment.

Findings

Early venous filling is associated with a 4.5-fold higher risk of hemorrhagic transformation after endovascular treatment.

Early venous filling increases the risk of symptomatic intracerebral hemorrhage by nearly 6-fold.

Patients with early venous filling have a 3.12-fold higher risk of poor 90-day outcomes.

Abstract

This meta‐analysis assessed the link between early venous filling (EVF) and hemorrhagic transformation (HT) post‐endovascular treatment (EVT) in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).

We searched PubMed, Embase, and Cochrane Library. Two reviewers independently screened studies, extracted data, and selected articles per preset criteria. The quality of included studies was assessed by the Newcastle–Ottawa Scale, and RevMan 5 was used for meta‐analysis. Stata 15 was used to test for publication bias.

Eight studies with 1758 AIS patients were included. EVF was associated with a higher HT rate after EVT (OR 4.5, 95% CI 3.47–5.85, p < 0.001). Subgroup analyses showed EVF was linked to higher incidences of hemorrhagic infarction (HI; OR 1.66, 95% CI 1.03–2.67, p = 0.04), parenchymal hematoma (PH; OR 3.86, 95% CI 2.55–5.83, p < 0.001), and symptomatic intracerebral hemorrhage (sICH; OR 5.95, 95% CI 2.99–11.83, p < 0.001). EVF was also related to a higher 90‐day poor prognosis rate (OR 3.12, 95% CI 2.14–4.54, p < 0.001).

This meta‐analysis shows EVF positively correlates with HT and poor prognosis after EVT, having significant implications for acute LVO stroke management.

In acute ischemic stroke patients caused by large vessel occlusion, early venous filling after endovascular treatment indicates a higher risk of hemorrhagic transformation and poor outcome. Adjust the treatment strategies timely may reduce the risk of symptomatic cerebral hemorrhage.

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