A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke.
A systematic review and meta-analysis of randomized controlled trials of endovascular thrombectomy compared with best medical treatment for acute ischemic stroke.
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DOI：
10.1111/ijs.12618
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Buchan AM
中科院分区：
文献类型：
--
作者：
Balami JS;Sutherland BA;Edmunds LD;Grunwald IQ;Neuhaus AA;Hadley G;Karbalai H;Metcalf KA;DeLuca GC;Buchan AM
涉及大血管闭塞的急性缺血性卒中在静脉溶栓治疗后通常再通不良。最近的研究表明，与单纯最佳药物治疗相比，血管内治疗的再通率和良好结局率更高。尚未进行一项系统综述和Meta分析，研究血管内血栓切除术的所有随机对照试验的受益，其中至少25%的患者使用血栓切除术器械治疗急性缺血性卒中，与最佳药物治疗相比。进行系统综述和Meta分析，评价血管内血栓切除术与最佳医疗护理相比治疗急性缺血性卒中的有效性。我们检索了437篇出版物，其中8项研究（共2423例患者）符合纳入标准。总体而言，血管内血栓切除术与功能结局改善相关（改良兰金量表0-2）[比值比1·56（1·32-1·85），P < 0·00001]。与单独使用最佳药物治疗相比，有降低死亡率的趋势[比值比0.84（0.67 - 1.05），P = 0.12]，症状性脑出血没有增加[比值比1.03（0.71 - 1.49），P = 0.88]。当每项试验中超过50%的病例使用新一代血栓切除器械时，良好功能结局的比值比增加至2.23（1.77 - 2.81，P <0.00001）。有明确的证据表明，与标准医疗护理相比，血管内血栓切除术可改善功能独立性，这表明血管内血栓切除术应被视为合格患者中血栓溶解的标准有效治疗。
Acute ischemic strokes involving occlusion of large vessels usually recanalize poorly following treatment with intravenous thrombolysis. Recent studies have shown higher recanalization and higher good outcome rates with endovascular therapy compared with best medical management alone. A systematic review and meta‐analysis investigating the benefits of all randomized controlled trials of endovascular thrombectomy where at least 25% of patients were treated with a thrombectomy device for the treatment of acute ischemic stroke compared with best medical treatment have yet to be performed. To perform a systematic review and a meta‐analysis evaluating the effectiveness of endovascular thrombectomy compared with best medical care for treatment of acute ischemic stroke. Our search identified 437 publications, from which eight studies (totaling 2423 patients) matched the inclusion criteria. Overall, endovascular thrombectomy was associated with improved functional outcomes (modified Rankin Scale 0–2) [odds ratio 1·56 (1·32–1·85), P < 0·00001]. There was a tendency toward decreased mortality [odds ratio 0·84 (0·67–1·05), P = 0·12], and symptomatic intracerebral hemorrhage was not increased [odds ratio 1·03 (0·71–1·49), P = 0·88] compared with best medical management alone. The odds ratio for a favorable functional outcome increased to 2·23 (1·77–2·81, P < 0·00001) when newer generation thrombectomy devices were used in greater than 50% of the cases in each trial. There is clear evidence for improvement in functional independence with endovascular thrombectomy compared with standard medical care, suggesting that endovascular thrombectomy should be considered the standard effective treatment alongside thombolysis in eligible patients.
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影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
3.7
作者：
Osanai, Toshiya;Pasupuleti, Vinay;Uchino, Ken
通讯作者：
Uchino, Ken
影响因子：
158.5
作者：
Berkhemer, O. A.;Fransen, P. S. S.;Dippel, D. W. J.
通讯作者：
Dippel, D. W. J.
DOI：
10.1056/nejmoa1214300
发表时间：
2013-03-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Broderick JP;Palesch YY;Demchuk AM;Yeatts SD;Khatri P;Hill MD;Jauch EC;Jovin TG;Yan B;Silver FL;von Kummer R;Molina CA;Demaerschalk BM;Budzik R;Clark WM;Zaidat OO;Malisch TW;Goyal M;Schonewille WJ;Mazighi M;Engelter ST;Anderson C;Spilker J;Carrozzella J;Ryckborst KJ;Janis LS;Martin RH;Foster LD;Tomsick TA;Interventional Management of Stroke (IMS) III Investigators
通讯作者：
Interventional Management of Stroke (IMS) III Investigators
影响因子：
168.9
作者：
Barber, PA;Demchuk, AM;Buchan, AM
通讯作者：
Buchan, AM