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Antegrade or Retrograde Approach for the Management of Tandem Occlusions in Acute Ischemic Stroke: Protocol for a Systematic Review and Meta-Analysis

Research Square (Research Square)(2020)

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Abstract
Abstract BackgroundAcute ischemic stroke (AIS) is a major contributor to global morbidity and mortality, and mechanical thrombectomy (MT) is an effective treatment for AIS. AIS caused by tandem intracranial and extracranial occlusions are not rare. Evidence for optimal MT strategy regarding order of treatment, including antegrade (extracranial first) or retrograde (intracranial first) approach is lacking. Therefore, a systematic review and meta-analysis is necessary to compare the two approaches for optimal management of tandem lesions in AIS.MethodsThis study will be performed with accordance to the PRISMA statement. Major databases including PubMed, Web of Science, Embase, and the Cochrane Library will be used for literature search. Randomized controlled trials and high-quality observational studies will be included. Risk of bias will be assessed using the Cochrane Collaboration criteria or Newcastle–Ottawa Scale according to type of study. Two reviewers will independently screen for eligible studies and perform data extraction. The primary outcomes are successful recanalization at post-intervention, and favorable outcome at 3-month follow-up. Secondary outcomes include duration of onset to arrival, onset to puncture, onset to recanalization, intracerebral hemorrhage, procedure and device related complications and mortality at 3-month follow-up. We will assess heterogeneity using the I2 statistic. Subgroup and sensitivity analyses will be performed to explore the sources of heterogeneity. Specific results will be described in narrative form when insufficient suitable studies are available for meta-analysis.DiscussionThis study will provide a reliable evidence base for antegrade or retrograde approach for the management of tandem lesions in AIS by synthesizing evidence from current pieces of literature comparing the two approaches, and also will provide updated clinical evidence of strategy selection and decision-making for this special group of patients. PROSPERO registration numberCRD42020199093
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Key words
acute ischemic stroke,tandem occlusions,systematic review,meta-analysis meta-analysis
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