The impact of recanalization on ischemic stroke outcome - A meta-analysis
The impact of recanalization on ischemic stroke outcome - A meta-analysis
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DOI：
10.1161/01.str.0000258112.14918.24
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发表时间：
2007-03-01
期刊：
影响因子：
8.3
通讯作者：
Saver, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Rha, Joung-Ho;Saver, Jeffrey L.
背景和目的-生物标志物作为一种辅助或替代结果的措施，它必须与功能性临床结果密切相关，并有因果关系。血管再通是急性卒中溶栓和机械再通治疗试验中功能结局的潜在替代结局标志物，但再通与临床结局的相关性先前尚未进行系统回顾。方法-通过Medline检索，我们从1985年至2002年期间发表的所有评估血管再通的文章中识别并提取再通和结局数据，无论是自发的或治疗诱导的，在急性缺血性stroke.Results -五十三项研究，包括2066例患者报道再通率。根据干预分类的再通率为：自发性（24.1%）、静脉溶栓（46.2%）、动脉内溶栓（63.2%）、静脉-动脉内联合（67.5%）和机械性（83.6%）。根据实现再通的成功或失败分类的临床结局数据可从33篇文章（包括998例患者）中获得。3个月时，再通患者的良好功能结局比未再通患者更常见，比值比为4.43（95% CI，3.32 - 5.91）。再通患者的3个月死亡率降低（比值比，0.24; 95%CI，0.16 - 0.35）。症状性出血转化率在两组之间没有差异（比值比，1.11; 95%CI，0.71 - 1.74）。结论-正式的荟萃分析证实了急性缺血性卒中再通和预后之间的强相关性。再通与改善功能结局和降低死亡率密切相关。这些结果表明，在急性缺血性卒中溶栓治疗的早期试验中，再通是治疗活性的适当生物标志物。
Background and Purpose - For a biomarker to serve as an auxiliary or surrogate outcome measure, it must be tightly correlated with and causally related to functional clinical outcome. Vessel recanalization is a potential surrogate outcome marker for functional outcome in trials of thrombolytic and mechanical recanalization therapies in acute stroke, but the correlation of recanalization and clinical outcome has not been previously systematically reviewed.Methods - Through Medline search, we identified and abstracted recanalization and outcome data from all articles published between 1985 and 2002 that assessed vessel recanalization, either spontaneous or therapeutically induced, in acute ischemic stroke.Results - Fifty-three studies encompassing 2066 patients reported recanalization rates. Recanalization rates categorized according to intervention were: spontaneous (24.1%), intravenous fibrinolytic (46.2%), intra-arterial fibrinolytic (63.2%), combined intravenous - intra-arterial (67.5%), and mechanical (83.6%). Clinical outcome data categorized by success or failure in achieving recanalization was available from 33 articles encompassing 998 patients. Good functional outcomes at 3 months were more frequent in recanalized versus nonrecanalized patients with odds ratio of 4.43 (95% CI, 3.32 to 5.91). Three-month mortality was reduced in recanalized patients ( odds ratio, 0.24; 95% CI, 0.16 to 0.35). Rates of symptomatic hemorrhagic transformation did not differ between the 2 groups ( odds ratio, 1.11; 95% CI, 0.71 to 1.74).Conclusions - Formal meta-analysis confirms a strong correlation between recanalization and outcome in acute ischemic stroke. Recanalization is strongly associated with improved functional outcomes and reduced mortality. These findings suggest that recanalization is an appropriate biomarker of therapeutic activity in early phase trials of thrombolytic treatment in acute ischemic stroke.