Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis.
Small Vessel Disease Burden and Outcomes of Mechanical Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis.
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缺血性中风机械血栓切除术的小血管疾病负担和结果：系统回顾和荟萃分析。
DOI：
10.3389/fneur.2021.602037
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发表时间：
2021
影响因子：
3.4
通讯作者：
Luo H
中科院分区：
文献类型：
--
作者：
Xu T;Wang Y;Yuan J;Chen Y;Luo H
背景：脑血管病（SVD）在人群中普遍存在，尤其是在老年人中。急性缺血性卒中（AIS）患者机械取栓（MT）与SVD的临床相关性仍存在很大的不确定性。目的：本系统综述和荟萃分析旨在评估接受MT治疗的AIS患者SVD与临床结果之间的关系。方法：我们系统地检索Medline、Embase和Cochrane数据库以获取相关临床研究。SVD暴露主要包括脑白质变、脑微出血（CMBs）和脑凹窝。合并OR用于计算SVD各亚型与MT预后之间的关联。主要结局是功能不良结局，定义为MT后90天修改的Rankin量表评分(mRS)≥3。次要结局包括90天死亡率、住院死亡率、颅内出血（ICH）和症状性颅内出血（sICH）、成功再通和无效再通（FR）、早期神经系统改善、MT后90天的预后。结果：总共纳入了20项研究，5189名AIS患者接受了MT。基线时高白质病变负担（HLB）与90天功能不良结局风险增加相关（OR 2.70, 95% CI 2.01-3.63; p < 0.001； 10项研究；n = 2004）、住院死亡率（OR 4.06, 95% CI 1.48-11.13; p = 0.006； 2项研究；n = 314）、FR （OR 5.00, 95% CI 2.86-8.73; p < 0.001； 3项研究；n = 493）和END (OR 2.65, 95% CI 1.09-6.45； 1项研究；基线时的HLB （VSS 3-4或FS≥2）与MT后90天的死亡率、ICH或sICH无关。基线时的CMBs与90天功能不良结局的风险增加相关(or 1.84, 95% CI 1.17-2.90; p = 0.008； 2项研究；n = 1,924)。我们发现，在手术后90天，腔隙的存在与功能不良之间没有关联。结论：在接受手术的AIS患者中，HLB和CMBs与手术后不良结果的风险增加有关。
Background: Cerebral small vessel disease (SVD) is prevalent in the population, especially among elderly individuals. Substantial uncertainties remain about the clinical relevance of SVD with outcomes of mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Objectives: This systematic review and meta-analysis was performed to evaluate the association between SVD and clinical outcomes in patients with AIS undergoing MT. Methods: We systematically searched the Medline, Embase, and Cochrane databases for relevant clinical studies. The exposure of SVD mainly included leukoaraiosis, cerebral microbleeds (CMBs), and lacunes. The pooled OR was used to calculate the association between each subtype of SVD and outcomes of MT. The primary outcome was poor functional outcome, which was defined as a modified Rankin Scale score (mRS) ≥3 at 90 days after MT. The secondary outcomes included mortality at 90 days, in-hospital mortality, intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH), successful recanalization and futile recanalization (FR), early neurological improvement, and early neurological deterioration (END) after MT. Results: Overall, 20 studies with 5,189 patients with AIS undergoing MT were included. High leukoaraiosis burden (HLB) at baseline was associated with increased risks of poor functional outcome at 90 days (OR 2.70, 95% CI 2.01–3.63; p < 0.001; 10 studies; n = 2,004), in-hospital mortality (OR 4.06, 95% CI 1.48–11.13; p = 0.006; 2 studies; n = 314), FR (OR 5.00, 95% CI 2.86–8.73; p < 0.001; 3 studies; n = 493), and END (OR 2.65, 95% CI 1.09–6.45; 1 study; n = 273) after MT. HLB (VSS 3–4 or FS ≥ 2) at baseline was not associated with mortality at 90 days, ICH, or sICH after MT. CMBs at baseline were found to be associated with increased risks of poor functional outcome at 90 days (OR 1.84, 95% CI 1.17–2.90; p = 0.008; 2 studies; n = 1,924) after MT. We found no association between the presence of lacunes and poor functional outcome at 90 days after MT. Conclusions: In patients with AIS undergoing MT, HLB and CMBs were associated with increased risks of unfavorable outcomes after MT.
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影响因子：
4.8
作者：
Benson, John;Seyedsaadat, Seyed Mohammad;Brinjikji, Waleed
通讯作者：
Brinjikji, Waleed
影响因子：
8.3
作者：
O'Sullivan, Michael
通讯作者：
O'Sullivan, Michael
影响因子：
8.3
作者：
Gratz, Pascal P.;El-Koussy, Marwan;Jung, Simon
通讯作者：
Jung, Simon
影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
9.9
作者：
Kongbunkiat K;Wilson D;Kasemsap N;Tiamkao S;Jichi F;Palumbo V;Hill MD;Buchan AM;Jung S;Mattle HP;Henninger N;Werring DJ
通讯作者：
Werring DJ