Implications of frailty in acute ischemic stroke receiving endovascular treatment: systematic review and meta-analysis

Background Frailty is a state of cumulative degeneration of bodily functions that is consistently associated with poor outcomes in older people following illness. Combined stroke intervention and frailty may yield additive and synergistic effects adults with stroke. Objective To evaluate the safety and efficacy of endovascular therapy (EVT) in frail patients. Methods We conducted a systematic review of the relationship between debilitation and acute ischemic stroke (AIS) after EVT. Until August 2022, researchers have searched three databases (Pubmed, EMBASE and Cochrane). Random-effects meta-analysis, combined ratio (OR) and 95% confidence interval (95%CI) were used to assess efficacy values. The I 2 statistic was used to assess heterogeneity. Comprehensive meta-analysis software was used for meta-analysis. Results We ultimately included eight studies including 3662 non-overlapping participants. Four studies used the Clinical Frailty Scale (CFS), two studies used the Hospital Frailty Risk Score (HFRS), a study used frailty index and a study used the comprehensive geriatric assessment (CGA). Frailty prevalence: 35%; 95% CI, 0.27–0.43; low quality evidence, downgraded due to heterogeneity, bias. Random effects showed that poor functional outcome (5 studies, OR 1.956, 95% CI 1.256–3.048) and mortality (9 studies, OR 2.320, 95% CI 1.680–3.205) was significantly associated with frailty. In adjusted analyses, poor functional outcome (4 studies, OR adj 1.189, 95% CI 1.043–1.357), and mortality (3 studies, OR adj 1.036, 95% CI 1.008–1.065) were significantly associated with frailty. Conclusion Pre-stroke frailty is an important predictor of poor prognosis assessed by EVT and can be added to the classical predictors of stroke outcome. Routine assessment of pre-stroke frailty can help patients to make decisions about the efficacy of their choice of EVT.