Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1371/journal.pone.0122806
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发表时间：
2015-04-27
期刊：
影响因子：
3.7
通讯作者：
Uchino, Ken
中科院分区：
文献类型：
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作者：
Osanai, Toshiya;Pasupuleti, Vinay;Uchino, Ken
背景：血管内治疗急性缺血性卒中的随机对照试验（RCT）结果不一致。我们评估了血管内治疗的疗效和安全性发表RCTs.MethodsWe进行了系统的回顾性研究随机对照试验血管内治疗与溶栓或机械再灌注相比，没有血管内治疗的干预。主要结局是良好功能结局的频率（90天时改良兰金量表（mRS）为0-2），次要结局是90天时的死亡率和症状性颅内出血（sICH）。随机效应荟萃分析和科克伦风险偏倚评估被用来评估证据的质量。血管内治疗与良好的功能结局无显著相关性（相对风险[RR] = 1.17; 95% CI，0.97 - 1.42; p=0.10和绝对风险差[ARD] = 7%; 95% CI -0.1%至14%; p=0.05）;研究间异质性为中度（I-2=30%）。血管内治疗的死亡率无变化（RR=0.92; 95% CI，0.75 - 1.13; p=0.45），sICH无差异（RR=1.20; 95% CI，0.79 - 1.82; p=0.39）。证据的质量是低的所有结果和建议是薄弱的血管内治疗的使用按照GRADE methodology.ConclusionsIntra-arterial治疗并没有显示出显着增加良好的结果，无论是死亡率或急性缺血性脑卒中患者的sICH没有变化。我们需要更多设计更好、质量更高的随机对照试验来评价血管内治疗的真实疗效。
BackgroundRandomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs.MethodsWe performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence.ResultsTen studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] = 1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] = 7%; 95% CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I-2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95% CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95% CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology.ConclusionsIntra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.