Intravenous thrombolysis versus dual antiplatelet therapy for patients with acute minor ischaemic stroke: a systematic review and meta-analysis.

Background and purpose: The efficacy of intravenous thrombolysis (IVT) in patients with acute minor ischaemic stroke (AMIS) remains unclear. We performed a meta-analysis to compare the efficacy and safety of IVT and dual antiplatelet therapy (DAPT) in patients with AMIS. Methods: The Embase, Cochrane Library, PubMed, and Web of Science databases were searched up to 10 October, 2023. Prospective and retrospective studies comparing the clinical outcomes of IVT and DAPT were included. Odds ratios (ORs) and 95% confidence intervals (CIs) for early neurological deterioration (END), excellent and favourable functional outcomes, recurrent ischaemic stroke at 3 months, mortality at 3 months, and symptomatic intracranial haemorrhage (ICH) were pooled using a random-effects model. Results: Of the five included studies, 6,340 patients were included. In patients with AMIS, IVT was not significantly associated with excellent and favourable functional outcomes, recurrent ischaemic stroke, or all-cause mortality at 3 months compared to early DAPT. However, a higher risk of symptomatic ICH (OR, 9.31; 95% CI, 3.39-25.57) and END (OR, 2.75; 95% CI, 1.76-4.30) were observed with IVT. Conclusion: This meta-analysis indicated that IVT was not superior to DAPT in patients with AMIS, especially in those with nondisabling AIS. However, these findings should be interpreted with caution and have some limitations. Further, well-designed randomised controlled trials are warranted.

Efficacy and Safety of the Soft Torqueable Catheter Optimized For Intracranial Access in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis.

OBJECTIVE: Acute ischemic stroke (AIS) is a severe, life-threatening type of stroke with poor prognosis and high recurrence rate, mainly attributed to large vessel occlusion (LVO). Improved understanding of the safety and effectiveness of the Soft Torqueable Catheter Optimized For Intracranial Access (SOFIA) for LVO-AIS might guide practitioners. Therefore, we conducted this study focusing on neurological outcomes, procedure-related complications, and recanalization rates. METHODS: We collected data in January 2022 from PubMed, Cochrane, Web of Science, and Embase. The study considered that assessed the effects of the SOFIA catheter in treatment of LVO-AIS. We extracted data narratively and expressed the results with the proportions and 95% confidence intervals (CI). RESULTS: We included 17 studies reporting on 2106 patients treated with the SOFIA catheter. The successful recanalization rate was 77% (95% CI, 71%-83%) with the SOFIA catheter alone and the application of a rescue stent-retriever was observed in 28% (95% CI, 23%-33%) of cases, resulting in an overall successful recanalization rate of 90% (95% CI, 87%-92%). A pooled estimate of 45% (95% CI, 39%-51%) was observed for functional independence at 90 days, 15% (95% CI, 11%-20%) for mortality at 90 days, and 5% (95% CI, 3%-8%) for symptomatic intracranial hemorrhage. CONCLUSIONS: This meta-analysis revealed that aspiration thrombectomy with the SOFIA catheter is a safer and effective treatment modality for LVO-AIS.

Association between the rs112735431 polymorphism of the RNF213 gene and moyamoya disease: A case-control study and meta-analysis.

Ring finger protein 213 (RNF213) gene polymorphisms are thought to be significant in the etiology and pathogenesis of moyamoya disease (MMD). Due to the rarity of MMD patients, their ethnic diversity, and the use of varying methodologies, studies of the association between these polymorphisms and MMD have not been repeatable. This lack of reproducibility affects the strength of the conclusions drawn from their results. We conducted the present case-control study and meta-analysis to provide more precise estimates of the association between the rs112735431 (c.14576G>A) polymorphism and the risk of MMD. A total of 81 MMD patients and 100 healthy controls were enrolled in our case-control study. The RNF213 rs112735431 (c.14576G>A) polymorphism was genotyped using Sanger sequencing after amplification with polymerase chain reaction (PCR). The genetic algorithm (GA) genotype and A allele frequencies of RNF213 rs112735431 (c.14576G>A) (odds ratio, OR=7.10, 95% confidence interval, CI=1.51-33.43, p=0.006; OR=9.37, 95% CI=2.10-41.84, p<0.001, respectively) were significantly higher in the MMD group than those in the control group. In our meta-analysis, we assessed a total of eight case-control studies, including 985 patients and 2335 controls. Pooled ORs indicated a significant association between the presence of the rs112735431 (c.14576G>A) polymorphism and MMD risk (dominant model: OR=74.55, 95% CI=35.86-154.98, p<0.00001). Subgroup analysis based on country and sensitivity analysis verified these results. Our case-control study and meta-analysis both provide evidence of an association between the rs112735431(c.14576G>A) polymorphism in the RNF213 gene and MMD risk.