大型缺血性中风的内血管血栓切除术:随机试验的活体系统审查和元分析
Rami Z Morsi1, Mohamed Elfil2, Hazem S Ghaith3
1Department of Neurology, University of Chicago, Chicago, IL, USA.
Journal of stroke
|June 7, 2023
概括
血管内血栓切除术 (EVT) 可以显著改善功能独立性急性缺血性中风 (AIS) 患者的大型心脏病发作. 有证据表明,可能会降低死亡率,并稍微增加带有 EVT 症状的内出血.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 公共卫生 公共卫生
背景情况:
- 内血管血栓切除术 (EVT) 越来越多地因其在治疗急性缺血性中风 (AIS) 患者的安全性和有效性而得到认可.
- 之前的研究表明,在特定的AIS患者队列中,EVT的积极结果.
- 需要对随机试验的证据进行全面,最新的综合分析.
研究的目的:
- 进行随机对照试验 (RCT) 的活体系统审查和元分析.
- 为了比较EVT的有效性和安全性与AIS患者的大缺血区域的单独医疗管理.
- 为临床决策提供基于证据的摘要.
主要方法:
- 在主要数据库 (MEDLINE,Embase,Cochrane Library) 系统搜索相关的RCT.
- 使用固定效应模型进行元分析,以评估功能独立性,死亡率和症状性内出血 (sICH).
- 通过使用Cochrane偏差风险工具评估研究质量,并通过推,评估,开发和评估 (GRADE) 方法对证据的确定性进行评估.
主要成果:
- 三个具有1,010名参与者的RCT被纳入了元分析.
- 低确定性证据表明,EVT可能会大大增加功能独立性 (RD 30.3%).
- 低确定性证据表明,可能会有很小,不显著的死亡率下降 (RD -0.7%) 和可能会有很小,不显著的SICH (RD 3.1%) 增加.
结论:
- 目前的低确定性证据表明,EVT可能会大大改善AIS患者的大型心脏病发作中的功能独立性.
- EVT对死亡率的影响似乎是最小的和不显著的,有潜在的轻微增加sICH.
- 需要进一步进行高质量的研究来证实这些发现,并完善治疗指南.
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