大核心体积的缺血性中风的内血管血栓切除术:一个更新的,TESLA后的系统性审查和随机试验的元分析
Hassan Kobeissi1,2, Gautam Adusumilli3, Sherief Ghozy1
1Department of Radiology, Mayo Clinic, Rochester, MN, USA.
概括
与医学疗法 (MEDT) 相比,内血管血栓切除术 (EVT) 显著改善了急性缺血性中风与广泛脑损伤的结果. 虽然EVT增加了症状性内出血的风险,但它会导致更好的功能恢复和早期的神经改善.
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:
- 存在有限的随机对照试验 (RCT),将内血管血栓切除术 (EVT) 与急性缺血性中风与广泛的基线缺血性损伤 (AIS-EBI) 的医疗治疗 (MEDT) 进行比较.
- 这项研究解决了对现有的RCT进行全面分析的需求,以评估EVT在这个特定患者群体中的有效性.
研究的目的:
- 为AIS-EBI系统地审查和元分析与EVT进行比较的RCT,并将其与MEDT进行比较.
- 评估与MEDT相比,EVT对功能结果,神经改善和安全的影响.
主要方法:
- 从开始到2023年2月,使用多个数据库 (Web of Science,Embase,Scopus,PubMed) 进行了系统的文献审查,包括TESLA试验结果.
- 包括将EVT与MEDT进行比较的RCT,用于具有较大的缺血核心体积的急性缺血性中风.
- 主要结局是修改后的Rankin分数 (mRS) 0-2. 二次结局包括早期神经改善 (ENI),mRS 0-3,成功的再输血 (TICI 2b-3),症状性内出血 (sICH) 和死亡率. 一个随机效应模型被用于分析.
主要成果:
- 分析了4项涉及1310名患者的RCT (661名EVT,649名MEDT).
- 与MEDT相比,EVT显著改善了mRS 0-2 (RR 2.33) 和mRS 0-3 (RR 1.68) 的发生率,并增强了ENI (RR 2.24) 的发生率.
- 症状性内出血 (sICH) 率在EVT中较高 (RR 1.99),但死亡率在不同组之间是可比的. 在EVT组中,成功的再输血率为79.9%.
结论:
- 血管内血栓切除术 (EVT) 对急性缺血性中风和广泛的基线缺血性损伤患者的医疗疗 (MEDT) 提供了显著的临床益处.
- 尽管有症状性内出血的风险增加,但EVT导致更好的功能结果和早期的神经改善,支持其在选择的AIS-EBI患者中使用.
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