Is mRankin scale correlated with modified-treatment-in-cerebral-infarction? A systematic review, meta-analysis and meta-regression on randomized controlled trial and registries.

Abstract PurposeThe purpose was to evaluate the numeric correlation between modified treatment in cerebral infarction (mTICI)≥2b/3 and modified Rankin Scale (mRS)≤2 in RCT and registries.Material and MethodsLiterature research was performed on Pubmed/OVID for studies in 2015-2021, mTICI, mRS and sample-size were recorded. Exclusion criteria were monocentric study, not-human and not-English. Studies qualities were assessed with MINORS/RoB2. Meta-analysis with random effect model was performed. Meta-logistic and meta-linear regressions were used to correlate mTICI and mRS in both RCTs and registries. Z-test was used for comparing coefficients between RCTs/registries.Results We evaluated thirty-four studies (17 registries; 17 RCTs) for 29540 patients (27031 from registries (median registry 1192.0 [CI95% 698.7-1992.8]; 2509 from RCTs [median RCT 165.0 [CI95% 98.1-234.0]). 10/17(58.8%) registries considered also vertebrobasilar system strokes. Overall mRs≤2 was 46.0 (CI95% 43.8-48.3) with I2=92.6%.The odd-ratio of obtaining a mRS≤2 for a singular increased of mTICI≥2b rate was: 1.49(CI95% 1.22-2.01) for all studies (for 1% increase of mTICI≥2b the odds for obtaining mRS≤2 was 1.49), 1.50(CI95% 1.00-2.23) for RCTs and 1.50(CI95% 1.10-2.23) for registries. mTICI≥2b and mRS had a positive correlation with coefficient of 0.49(CI95% 0.22-0.75, p=0.001) for all studies (for 1% increase of mTICI≥2b the mRS≤2 rate augment by 0.49%), 0.51(CI95% 0.10-0.91) for RCTs and 0.46(CI 95% 0.09-0.84) for registries.No differences were found in coefficients between RCTs/registries (p=0.50; p=0.57; respectively).ConclusionsUnitary increased of mTICI≥2b rate correspond to an augment of mRS≤2 by 0.49(CI95% 0.22-0.75) with odd-ratio of obtaining mRS≤2 of 1.49(CI95% 1.22-2.01), without significantly differences in coefficients.