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Impact of Periprocedural Hemoglobin Level on the Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke Patients
Published online by Cambridge University Press: 02 April 2025
Abstract
Background:
Endovascular thrombectomy (EVT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple factors can influence EVT outcomes, including procedural and patient-related variables. This meta-analysis investigated the impact of periprocedural hemoglobin (Hb) levels on EVT outcomes.
Methods:
We performed a comprehensive literature search across PubMed, Scopus, Web of Science and Cochrane CENTRAL. We analyzed the mean difference (MD) in Hb levels between good (modified Rankin Scale [mRS] 0–2) and poor (mRS 3–6) prognosis groups. We calculated pooled odds ratios (OR) for Hb levels as a predictor of prognosis and compared mortality and symptomatic intracranial hemorrhage (sICH) across different Hb levels.
Results:
The analysis included 921 patients from four studies. Patients in the good prognosis group had significantly higher Hb levels (MD: 0.48 g/dL, 95% CI: [0.2, 0.75], P = 0.0007). Each 1 g/dL increase in Hb was associated with a 22% increase in the odds of achieving a good three-month prognosis (OR: 1.22, 95% CI: [1.13, 1.33], P < 0.00001). Patients with Hb levels ≤13 g/dL in males and ≤12 g/dL in females were 1.69 times more likely to experience mortality (OR: 1.69, 95% CI: [1.1, 2.59], P = 0.02). No significant difference was observed in sICH occurrence between anemic and non-anemic patients.
Conclusion:
Higher Hb levels may be associated with improved prognosis, and lower Hb levels might increase mortality risk in AIS-LVO patients undergoing EVT. Further research is needed to validate these findings.
Résumé
Impact des taux d’hémoglobine péri-procéduraux sur les résultats de la thrombectomie endovasculaire chez des patients victimes d’un AVC ischémique aigu.
La thrombectomie endovasculaire (TEV) est le traitement de référence pour les patients victimes d’un AVC ischémique aigu entraînant une occlusion des gros vaisseaux sanguins (OGVS). De multiples facteurs peuvent influencer les résultats de la thrombectomie endovasculaire, y compris des variables liées à la procédure elle-même et aux patients. Cette méta-analyse a donc étudié l’impact des taux d’hémoglobine (Hb) péri-procéduraux sur les résultats de la TEV.
Nous avons effectué une recherche documentaire exhaustive dans PubMed, Scopus, Web of Science et CENTRAL. Nous avons ensuite analysé la différence moyenne (DM) des taux d’Hb entre les groupes offrant un bon pronostic (échelle de Rankin modifiée [ERM] 0-2) et un mauvais pronostic (ERM 3-6). Nous avons calculé les rapports de cote (RC) regroupés pour les taux d’Hb en tant que prédicteurs du pronostic et comparé les taux de mortalité et la présence d’hémorragie intracrânienne symptomatique (HICS) en fonction des différents niveaux d’Hb.
Notre analyse a porté sur 921 patients issus de quatre études. Les patients des groupes offrant un bon pronostic avaient des taux d’Hb significativement plus élevés (DM : 0,48 g/dL ; IC 95 % : [0,2-0,75], p = 0,0007). Chaque augmentation de 1 g/dL du taux d’Hb était associée à une augmentation de 22 % de chance d’obtenir un bon pronostic au bout de trois mois (RC : 1,22 ; IC 95 % : [1,13-1,33], p < 0,00001). Les patients ayant un taux d’Hb ≤ 13 g/dL chez les hommes et ≤ 12 g/dL chez les femmes avaient 1,69 fois plus de chance de décéder (RC : 1,69 ; IC 95 % : [1,1-2,59], p = 0,02). Finalement, aucune différence notable entre les patients anémiques et non anémiques n’a été observée en ce qui regarde la présence d’une HICS.
Des taux d’Hb plus élevés peuvent être associés à un meilleur pronostic alors que des taux d’Hb plus bas peuvent augmenter le risque de mortalité chez des patients victimes d’un AVC ischémique aigu entraînant une OGVS et devant subir une TEV. Chose certaine, des recherches supplémentaires sont nécessaires pour valider de tels résultats.
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Impact of Periprocedural Hemoglobin Level on the Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke Patients
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