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对于急性缺血性中风的内血管血栓切除术:一个元分析
Jetan H Badhiwala1, Farshad Nassiri1, Waleed Alhazzani2
1Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
JAMA
|November 4, 2015
概括
与标准治疗相比,急性缺血性中风的机械血栓切除显著改善功能结果和复血管化率. 这种内血管干预显然有好处,但不增加出血或死亡风险.
科学领域:
- 神经学
- 干预心脏病学
- 血管外科
背景情况:
- 对于急性缺血性中风的内血管干预改善了复血管化,但功能结果有所不同.
- 内血管干预的子组效应需要更好的定义.
研究的目的:
- 检查急性缺血性中风患者内血管机械血栓切除术与临床结果之间的关联.
主要方法:
- 在多个数据库 (MEDLINE,EMBASE,CINAHL,Google Scholar,Cochrane Library) 进行系统搜索,直到2015年8月.
- 符合条件的随机临床试验的元分析,将内血管血栓切除与标准医疗保健 (包括静脉tPA) 进行比较.
- 功能独立性分析 (mRS 0-2),重血管化,症状性内出血,以及90天的所有原因死亡率.
主要成果:
- 在修改的兰金尺度 (mRS) 评分上,内血管治疗显示出显著的益处 (OR,1. 56).
- 功能独立性 (mRS 0- 2) 在内血管治疗 (44. 6%) 和标准治疗 (31. 8%) 中较高.
- 血管内血栓切除术的血管再血管化率显著提高 (75. 8% vs 34. 1%);症状性内出血或90天死亡率没有显著差异.
结论:
- 在急性缺血性中风患者中,通过机械血栓切除的内血管治疗与改善的功能结果有关.
- 机械血栓切除显著增加血管再血管化率.
- 与标准医疗护理相比,没有发现症状性内出血或全因死亡率的显著增加.
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