5つのランダム化試験の個々の患者データのメタ解析

Mayank Goyal¹, Bijoy K Menon¹, Wim H van Zwam²

¹Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada.

Lancet (London, England)

|February 23, 2016

まとめ

血管内血栓切除は,大血管閉塞の急性性不全性脳卒中の患者の障害を大幅に軽減します. この効果的な治療は,年齢や治療開始までの時間に関係なく,ほとんどの患者に恩恵を与え,全般的に結果を改善します.

科学分野:

神経学
介入心臓科
公衆衛生

背景:

2015年に実施された5つのランダム化試験では,急性不全性脳卒中の標準治療よりも,血管内血栓切除が有効であることが示されました.
多様な患者集団における効果を確認するには,さらなる分析が必要であった.

研究の目的:

5つの主要な臨床試験 (MR CLEAN,ESCAPE,REVASCAT,SWIFT PRIME,EXTEND IA) の個々の患者データをまとめました
前側近循環の大血管閉塞による急性性不全性脳卒中の患者における血管内血栓切除術の有効性を評価する.
様々な患者サブグループにおける治療効果の異質性を調べる.

主な方法:

1287人の患者のデータ (634人の血栓切除,653人の対照) のメタ分析.
主要アウトカム (90日後に修正されたランキンスケールによる障害の減少) を分析するために,混合効果モデルを使用した.
分析には,年齢,性別,脳卒中重症度,閉塞部位,IVアルテプラスの使用,および治療までの時間が含まれていた.

主要な成果:

血管内血栓切除は90日後に有意に障害を軽減しました (調整された共通確率比 [cOR] 2. 49).
治療に必要な数はmRSで障害を1レベル減らすために2. 6でした.
高齢患者,発症から300分以上で治療を受けた患者,IVアルテプラスを投与できない患者など,治療の効果は各サブグループで一貫していました.

結論:

大血管閉塞による急性不全性脳卒中のほとんどの患者に有益です.
治療の有効性は,患者様と地理的な場所の違いによって一貫しています.
この発見は,脳卒中治療システムのグローバルな再構築を支えており,内静脈性血栓切除の手術を適時に行うことができるようにしています.

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