Endovascular Treatment with Stent-Retriever Devices for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.
Endovascular Treatment with Stent-Retriever Devices for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.
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DOI：
10.1371/journal.pone.0147287
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Kelly T
中科院分区：
文献类型：
--
作者：
Bush CK;Kurimella D;Cross LJ;Conner KR;Martin-Schild S;He J;Li C;Chen J;Kelly T
急性缺血性中风是世界范围内导致死亡和残疾的主要原因。最近的几项临床试验表明，血管内治疗改善了急性缺血性中风患者的临床结果。目的：全面、准确地评估主要使用第二代机械取栓装置(支架取回器装置)的血管内治疗与药物治疗对急性缺血性卒中患者的临床和功能结果的影响。Medline、EMBASE、Cochrane Collaboration Central Register Of Control临床试验、Web of Science和NIH ClinicalTrials.gov被搜索到2015年11月。搜索返回3045篇文章。在去掉重复之后，两位作者独立筛选了标题和摘要，以评估2495份可能相关的出版物的资格。从中，对38种全文出版物进行了更仔细的评估。最后，选择了5个以可回收支架为主的血管内治疗的随机对照试验。三位作者使用标准化方案独立提取了关于参与者和试验特征以及临床事件的信息。随机效应模型用于汇集不同结局的血管内治疗效果。主要结果是，在90天的随访中，根据改良的Rankin评分，功能结果更好。次要结果包括全因死亡率和症状性脑内出血。包括代表1287名患者的5项试验。总体而言，随机接受血管内治疗的患者比随机接受内科治疗的患者获得更好功能结果的几率高2.22倍(95%可信区间，1.66比2.98；P<；0.0001)。血管内治疗与死亡率[OR(95%CI)，0.78(0.54，1.12)；P=0.1056]和症状性脑出血[OR(95%CI)，1.19(0.69，2.05)；P=0.5348]无关。Meta回归分析显示，卒中起病至腹股沟穿刺术和卒中起病至再通时间越短，功能预后越好(P=0.0077和P=0.0089)。血管内治疗对不同性别、年龄、卒中严重程度、CT显示的缺血性改变或静脉注射组织纤溶酶原激活剂的患者的功能结果的有益影响没有显著差异。这项荟萃分析显示，与内科治疗相比，接受血管内治疗的受试者具有更好的功能结果。此外，这项分析表明，急性缺血性中风患者可能会从早期血管内治疗中获得增强的功能益处。
Acute ischemic stroke is a leading cause of death and disability worldwide. Several recent clinical trials have shown that endovascular treatment improves clinical outcomes among patients with acute ischemic stroke. To provide an overall and precise estimate of the efficacy of endovascular treatment predominantly using second-generation mechanical thrombectomy devices (stent-retriever devices) compared to medical management on clinical and functional outcomes among patients with acute ischemic stroke. MEDLINE, EMBASE, Cochrane Collaboration Central Register of Controlled Clinical Trials, Web of Science, and NIH ClinicalTrials.gov were searched through November 2015. Searches returned 3,045 articles. After removal of duplicates, two authors independently screened titles and abstracts to assess eligibility of 2,495 potentially relevant publications. From these, 38 full-text publications were more closely assessed. Finally, 5 randomized controlled trials of endovascular treatment with predominant use of retrievable stents were selected. Three authors independently extracted information on participant and trial characteristics and clinical events using a standardized protocol. Random effects models were used to pool endovascular treatment effects across outcomes. The primary outcome was better functional outcome as measured on the modified Rankin Scale at 90 days of follow-up. Secondary outcomes included all-cause mortality and symptomatic intra-cerebral hemorrhage. Five trials representing 1,287 patients were included. Overall, patients randomized to endovascular therapy experienced 2.22 times greater odds of better functional outcome compared to those randomized to medical management (95% CI, 1.66 to 2.98; P < 0.0001). Endovascular therapy was not associated with mortality [OR (95% CI), 0.78 (0.54, 1.12); P = 0.1056] or symptomatic intracerebral hemorrhage [OR (95% CI), 1.19 (0.69, 2.05); P = 0.5348]. Meta-regression analysis suggested that shorter times from stroke onset to groin puncture and from stroke onset to reperfusion result in better functional outcomes in ischemic stroke patients (P = 0.0077 and P = 0.0089). There were no significant differences in the beneficial effects of endovascular treatment on functional outcomes across categories of gender, age, stroke severity, ischemic changes on computed tomography, or intravenous tissue plasminogen activator administration. This meta-analysis demonstrated superior functional outcomes in subjects receiving endovascular treatment compared to medical management. Further, this analysis showed that acute ischemic stroke patients may receive enhanced functional benefit from earlier endovascular treatment.