急性不全性脳卒中における血管内血栓切除:メタ解析

Jetan H Badhiwala¹, Farshad Nassiri¹, Waleed Alhazzani²

¹Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.

JAMA

|November 4, 2015

まとめ

急性性不全性脳卒中における機械的血栓切除は標準治療と比較して機能的結果と再血管化率を大幅に改善しますこの血管内干渉は,出血や死亡のリスクを高めることなく,明らかな利点を示しています.

科学分野:

神経学
介入心臓科
血管外科

背景:

急性不全性脳卒中の内血管介入は再血管化を改善しますが,機能的な結果は異なります.
血管内干渉のサブグループ効果は,より明確な定義が必要である.

研究の目的:

急性不全性脳卒中患者の内血管力学的血栓切除と臨床結果の関連性を調べる.

主な方法:

2015年8月まで複数のデータベース (MEDLINE,EMBASE,CINAHL,Google Scholar,Cochrane Library) で体系的な検索を行いました.
適格なランダム化臨床試験のメタ解析で,血管内血栓切除と標準的な医療 (静脈内TPAを含む) を比較した.
機能的独立性 (mRS 0 - 2),再血管化,症状性頭蓋内出血,全原因死亡率の分析

主要な成果:

修飾されたランキンスケール (mRS) スコア (OR,1. 56) において,内血管治療は有意な効果を示した.
機能的独立性 (mRS 0 - 2) は,標準治療 (31. 8%) と比べて,内血管治療 (44. 6%) で高かった.
血管内血栓切除では,血管学的再循環率 (75. 8% 対 34. 1%) が著しく高かったが,症状のある頭蓋内出血や90日間の死亡率は有意な差異はなかった.

結論:

メカニカル・トロンベクトミーによる内血管治療は,急性性不全性脳卒中患者の機能的結果の改善と関連しています.
メカニカル・トロンベクトミーは血管再循環率を大幅に増加させる.
症状のある頭蓋内出血やあらゆる原因による死亡率の有意な増加は,標準的な医療と比較して観察されなかった.

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