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大血管缺血性中风后的内血管血栓切除术:来自五项随机试验的个体患者数据的元分析
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
概括
在患有大血管封闭的急性缺血性中风患者中,血管内血栓切除显著减少残疾. 这种有效的治疗对大多数患者来说都是有益的,不论年龄或治疗时间如何,整体改善了治疗结果.
科学领域:
- 神经学
- 干预心脏病学
- 公共卫生
背景情况:
- 2015年进行的五项随机试验证明了内血管血栓切除对急性缺血性中风的标准治疗的有效性.
- 需要进一步的分析来确认不同患者群体的益处.
研究的目的:
- 来自五项主要试验 (MR CLEAN,ESCAPE,REVASCAT,SWIFT PRIME,EXTEND IA) 的个人患者数据进行汇总.
- 在急性缺血性中风患者中评估内血管血栓切除术的疗效.
- 检查不同患者小组的治疗效果异质性.
主要方法:
- 对1287名参与者的个人患者数据进行了元分析 (634人进行了血栓切除,653人为对照组).
- 用混合效应模型分析主要结果 (在90天后通过修改的兰金尺度减少残疾).
- 分析包括根据年龄,性别,中风严重程度,阻塞部位,静脉输血高位素的使用和治疗时间进行调整.
主要成果:
- 血管内血栓切除术显著减少了90天的残疾 (调整后的常见几率比率[cOR]为2. 49).
- 需要治疗的患者数量为2. 6人,使残疾减少1个mRS水平.
- 治疗效益在各个小组中一致,包括老年患者,在发病后300分钟接受治疗的患者和无法接受IV高血压治疗的患者.
结论:
- 血管内血栓切除术对大多数因大血管封闭而引起的急性缺血性中风患者是有益的.
- 治疗效果在不同患者特征和地理位置上是一致的.
- 这些发现支持全球中风护理系统的重组,以确保及时获得内血管血栓切除术.
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