title: Systematic review and meta-analysis of interventions tested in animal models of lacunar stroke.
abstract: OBJECTIVE
  A total of 25% of strokes are lacunar, and these are pathophysiologically different from large artery strokes. Despite emerging evidence of a substantial impact on physical disability and dementia, little attention has been paid to the development of specific treatments. The optimal use of the animal models of lacunar stroke used to test candidate interventions is not known.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of studies testing candidate interventions in animal models of lacunar stroke. We used random-effects meta-analysis to assess the impact of study characteristics and trim and fill to seek evidence of publication bias.
  
  
  RESULTS
  The efficacy of 43 distinct interventions was described in 57 publications. The median number of quality checklist items scored was 3 of 8 (interquartile range, 2-4). Many models reflected mechanisms of limited relevance to lacunar stroke. Meta-analysis of results from 27 studies showed that on average, infarct size and neurobehavioral outcome were improved by 34.2% (24.1-44.2) and 0.82 standardized mean difference (0.51-1.14), respectively. Four interventions improved both infarct size and neurobehavioral outcome but there were insufficient data for this finding to be considered robust. For infarct size, efficacy was lower in studies reporting blinding and higher in studies reporting randomization. For neurobehavior, efficacy was lower in randomized studies. For infarct size there was evidence of publication bias.
  
  
  CONCLUSIONS
  No intervention has yet been tested in sufficient range and depth to support translation to clinical trial. There is limited reporting of measures to reduce the risk of bias and evidence for a substantial publications bias.
authors.affiliation: From the Department of Clinical Neurosciences, Western General Hospital, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
authors.forename: Hugo
authors.initials: H
authors.lastname: Pedder
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Vesterinen
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Macleod
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
mesh_terms: D000818:Animals; D001522:Behavior, Animal / Q000187:drug effects; D002544:Cerebral Infarction / Q000473:pathology; D003627:Data Interpretation, Statistical; D004195:Disease Models, Animal; D020767:Intracranial Thrombosis / Q000503:physiopathology / Q000628:therapy; D051379:Mice; D008863:Microspheres; D017594:Publication Bias; D011897:Random Allocation; D051381:Rats; D012107:Research Design; D059409:Stroke, Lacunar / Q000628:therapy*
keywords: , lacunar; meta-analysis; review, systematic; stroke