Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes.
Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes.
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血栓切除术技术的首过效应的当前发生率及其与临床结局的相关性的系统综述和荟萃分析。
DOI：
10.1136/neurintsurg-2020-016869
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发表时间：
2021-03
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
作者：
机械取栓术中的首过效应(FPE)被认为与良好的临床结果相关。我们进行了这项研究，以确定血栓切除技术对FPE发生率的影响，并比较接受和不接受FPE的患者的临床结果。并于2020年7月对FPE(单次通过后定义为mTICI2c-3)、改良FPE(mFPE，单次通过后定义为TICI2b-3)和机械取栓术治疗卒中的文献进行检索。使用随机效应Meta分析，我们评估了FPE和MFPE的以下结果：总的发生率、血栓切除技术的比率、神经功能良好的比率(第90天的改良朗肯评分(MRS)≤2)、死亡率和SICH比率。共纳入67项研究，涉及16,870名患者。FPE和MFPE的总发生率分别为28%和45%。血栓摘除技术的FPE(p=0.17)和mFPE(p=0.20)的发生率相似。当我们比较FPE与非FPE(56%比41%，OR 1.78)和mFPE与非mFPE(57%比44%，OR 1.73)时，发现良好的神经学结果的几率更高。FPE组病死率(17%)低于非FPE组(25%，0.62)。与非FPE和非MFPE相比，FPE和mFPE的SICH发生率(4%比18%，OR 0.41；5%比7%，OR 0.98)无相关性。我们的研究结果表明，大约三分之一的患者实现了FPE，大约一半的患者实现了MFPE，在整个血栓切除技术中，结果是相同的。FPE和MFPE与更好的临床结果相关。
First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes. We performed this study to determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE. In July 2020, a literature search on FPE (defined as mTICI2c-3 after single pass) and modified FPE (mFPE, defined as TICI2b-3 after single pass) and mechanical thrombectomy for stroke was performed. Using random-effects meta-analysis, we evaluated following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale (mRS) ≤2 at day 90), mortality, and sICH rate. Sixty seven studies comprising 16,870 patients were included. Overall rates of FPE and mFPE were 28% and 45% respectively. Thrombectomy techniques shared a similar FPE (p=.17) and mFPE (p=.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR 1.78) and mFPE with non-mFPE (57% vs 44%, OR 1.73). FPE had lower mortality rate (17% vs 25%, OR 0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared to non-FPE and non-mFPE (4% vs 18%, OR 0.41 for FPE; 5% vs 7%, OR 0.98 for mFPE). Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques.FPE and mFPE are associated with better clinical outcomes.
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影响因子：
1.7
作者：
Akpinar, Cetin K.;Ozdemir, Atilla O.;Giray, Semih
通讯作者：
Giray, Semih
影响因子：
4.8
作者：
Ducroux, Celina;Piotin, Michel;Fahed, Robert
通讯作者：
Fahed, Robert
影响因子：
2
作者：
Colby, Geoffrey P.;Baharyandat, Humain;Duckwiler, Gary
通讯作者：
Duckwiler, Gary
影响因子：
8.3
作者：
Garcia-Tornel, Alvaro;Requena, Manuel;Ribo, Marc
通讯作者：
Ribo, Marc
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N