Endovascular Thrombectomy for the Treatment of Large Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Control Trials
Endovascular Thrombectomy for the Treatment of Large Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Control Trials
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DOI：
10.1227/neu.0000000000002610
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发表时间：
2024-01-01
期刊：
影响因子：
4.8
通讯作者：
Harrigan, Mark R.
中科院分区：
文献类型：
--
作者：
Atchley, Travis J.;Estevez-Ordonez, Dagoberto;Harrigan, Mark R.
背景和结论：血管内血栓切除术以前被保留用于小到中度急性缺血性卒中患者。最近的三项随机对照试验证明了血栓切除术在大容量缺血性卒中中的功能获益和风险特征。Meta分析的主要目的是确定血管内血栓切除术在大容量缺血性卒中患者中的综合获益，并确定治疗后不良事件的风险。方法：我们系统地检索了医学文献分析和检索系统在线、Excerpta Medica数据库、Scopus、科克伦中心注册中心和Google Scholar，以查找2010年1月1日至2023年2月19日期间发表的随机试验。我们纳入了专门比较血管内血栓切除术与药物治疗急性缺血性卒中伴大体积梗死（定义为阿尔伯塔卒中项目早期计算机断层扫描评分3-5分或计算的梗死体积>50 mL）成人的试验。根据研究方法和设计、受试者特征、分析方法和疗效/安全性结局的预定变量提取数据。使用限制性最大似然估计随机效应模型将结果合并。评估研究的潜在偏倚和证据质量。主要结果是一个整体的顺序转变，在90天后，任何一个治疗arm. Results：三千四十四个研究进行了筛选，和29个进行了全文审查的改良兰金量表评分朝着一个更好的结果。三项随机试验（N = 1011）被纳入分析。主要结局的合并随机效应模型支持血管内血栓切除术优于药物治疗，广义比值比为1.55（95% CI 1.25-1.91，I-2 = 42.84%）。血栓切除术组中症状性颅内出血的风险有增加的趋势，相对风险为1.85（95% CI 0.94-3.63，I-2 = 0.00%）。结论：在大容量缺血性卒中患者中，血管内血栓切除术具有明确的功能获益，与单独药物治疗相比，不会增加重大并发症的风险。
BACKGROUND AND OBJECTIVES: Endovascular thrombectomy has previously been reserved for patients with small to medium acute ischemic strokes. Three recent randomized control trials have demonstrated functional benefit and risk profiles for thrombectomy in large -volume ischemic strokes. The primary objective of the meta -analysis was to determine the combined benefit of endovascular thrombectomy in patients with large -volume ischemic strokes and to determine the risk of adverse events after treatment. METHODS: We systematically searched Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Scopus, the Cochrane Central Register, and Google Scholar for randomized trials published between January 1, 2010, and February 19,2023. We included trials specifically comparing endovascular thrombectomy with medical therapy in adults with acute ischemic stroke with large -volume infarctions (defined by Alberta Stroke Program Early Computed Tomography Score 3-5 or a calculated infarct volume of >50 mL). Data were extracted based on prespecified variables on study methods and design, participant characteristics, analysis approach, and efficacy/safety outcomes. Results were combined using a restricted maximum -likelihood estimation random -effects model. Studies were assessed for potential bias and quality of evidence. The primary outcome was an overall ordinal shift across modified Rankin scale scores toward a better outcome at 90 days after either treatment arm. RESULTS: Three thousand forty-four studies were screened, and 29 underwent full -text review. Three randomized trials (N = 1011) were included in the analysis. The pooled random -effects model for the primary outcome favored endovascular thrombectomy over medical management, with a generalized odds ratio of 1.55 (95% CI 1.25-1.91, I-2 = 42.84%). There was a trend toward increased risk of symptomatic intracranial hemorrhage in the thrombectomy group, with a relative risk of 1.85 (95% CI 0.94-3.63, I-2 = 0.00%). CONCLUSION: In patients with large -volume ischemic strokes, endovascular thrombectomy has a clear functional benefit and does not confer increased risk of significant complications compared with medical management alone.