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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

Zaid Najdawi ,
Mohamed Elfil Open the ORCID record for Mohamed Elfil [Opens in a new window] ,
Abdallah Abbas ,
Lilian Maria Godeiro Coelho ,
Ahmed Samir ,
Sharon Peng ,
Mohammad Aladawi Open the ORCID record for Mohammad Aladawi [Opens in a new window] ,
Hazem S. Ghaith ,
Mohammad El-Ghanem  and
Chirag D. Gandhi
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Zaid Najdawi
Affiliation:
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
Mohamed Elfil
Affiliation:
Department of Neurology, University of Miami/Jackson Health System, Miami, FL, USA
Abdallah Abbas
Affiliation:
Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Lilian Maria Godeiro Coelho
Affiliation:
Department of Neurology, University of Miami/Jackson Health System, Miami, FL, USA
Ahmed Samir
Affiliation:
Faculty of Medicine, Al-Azhar University, Damietta, Egypt
Sharon Peng
Affiliation:
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
Mohammad Aladawi
Affiliation:
Department of Neurology, University of Alabama, Birmingham, AL, USA
Hazem S. Ghaith
Affiliation:
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Mohammad El-Ghanem
Affiliation:
Department of Clinical Sciences, University of Houston. HCA Houston Healthcare/ HCA Northwest Medical Center, Houston, TX, USA
Chirag D. Gandhi
Affiliation:
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
Fawaz Al-Mufti*
Affiliation:
Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
*
Corresponding author: Fawaz Al-Mufti; Email: Fawaz.Al-Mufti@wmchealth.org
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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

RÉSUMÉ

Impact des taux d’hémoglobine péri-procéduraux sur les résultats de la thrombectomie endovasculaire chez des patients victimes d’un AVC ischémique aigu.

Contexte :

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.

Méthodes :

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.

Résultats :

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.

Conclusion :

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.

Keywords

strokethrombectomyhemoglobinanemiameta-analysis

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 8
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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