Mechanical Thrombectomy for Acute Ischemic Stroke A Meta-Analysis of Randomized Trials
Mechanical Thrombectomy for Acute Ischemic Stroke A Meta-Analysis of Randomized Trials
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DOI：
10.1016/j.jacc.2015.09.070
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发表时间：
2015-12-08
影响因子：
24
通讯作者：
Bavry, Anthony A.
中科院分区：
文献类型：
--
作者：
Elgendy, Islam Y.;Kumbhani, Dharam J.;Bavry, Anthony A.
急性缺血性卒中是世界范围内严重残疾和死亡的主要原因。个体随机试验显示，与单独常规治疗相比，常规治疗后机械血栓切除术可能具有获益（即，静脉溶栓）在急性缺血性中风患者的管理中的应用。结论本研究系统地确定了在常规护理后机械血栓切除术是否与大动脉闭塞引起的急性缺血性中风患者的更好结局相关。使用DerSimonian和Laird模型构建随机效应汇总风险比（RR）。与单纯常规治疗相比，机械血栓切除术与获得良好功能结局（定义为改良兰金量表（mRS）0 - 2分）的较高发生率相关（RR：1.45; 95%置信区间[CI]：1.22 - 1.72; p < 0.0001）和功能结局极佳，定义为mRS 0 - 1（RR：1.67; 95% CI：1.27至2.19; p < 0.0001）。机械血栓切除术的全因死亡率有降低的趋势（RR：0.86; 95% CI：0.72 - 1.02; p = 0.09）。两种治疗方式发生症状性颅内出血的风险相似（RR 1.06：95% CI：0.73 ~ 1.55; p = 0.76）。结论：在大动脉闭塞所致急性缺血性卒中中，与单纯常规护理相比，常规护理后的机械血栓切除术与改善的功能结局相关，并且被发现相对安全，没有颅内出血机械血栓切除术的全因死亡率有降低趋势。(C)2015年由美国心脏病学会基金会。
BACKGROUND Acute ischemic stroke is a leading cause of serious disability and death worldwide. Individual randomized trials have shown possible benefits of mechanical thrombectomy after usual care compared with usual care alone (i.e., intravenous thrombolysis) in the management of acute ischemic stroke patients.OBJECTIVES This study systematically determined if mechanical thrombectomy after usual care would be associated with better outcomes in patients with acute ischemic stroke caused by large artery occlusion.METHODS The authors included randomized trials that compared mechanical thrombectomy after usual care versus usual care alone for acute ischemic stroke. Random effects summary risk ratios (RR) were constructed using a DerSimonian and Laird model.RESULTS Nine trials with 2,410 patients were available for analysis. Compared with usual care alone, mechanical thrombectomy was associated with a higher incidence of achieving good functional outcome, defined as a modified Rankin scale (mRS) of 0 to 2 (RR: 1.45; 95% confidence interval [CI]: 1.22 to 1.72; p < 0.0001) and excellent functional outcome defined as mRS 0 to 1 (RR: 1.67; 95% CI: 1.27 to 2.19; p < 0.0001) at 90 days. There was a trend toward reduced all-cause mortality with mechanical thrombectomy (RR: 0.86; 95% CI: 0.72 to 1.02; p = 0.09). The risk of symptomatic intracranial hemorrhage was similar with either treatment modality (RR 1.06: 95% CI: 0.73 to 1.55; p = 0.76).CONCLUSIONS In acute ischemic stroke due to large artery occlusion, mechanical thrombectomy after usual care was associated with improved functional outcomes compared with usual care alone, and was found to be relatively safe, with no excess in intracranial hemorrhage. There was a trend for reduction in all-cause mortality with mechanical thrombectomy. (C) 2015 by the American College of Cardiology Foundation.