大型缺血性中风的内血管血栓切除术:随机临床试验的更新活体系统性审查和元分析
Rami Z Morsi1, Mohamed Elfil2, Hazem S Ghaith3
1Department of Neurology, University of Chicago, Chicago, IL, USA.
Journal of the neurological sciences
|April 19, 2024
概括
内血管血栓切除术 (EVT) 显示,急性缺血性中风 (AIS) 患者的功能独立性有所改善. 然而,这种治疗也会增加症状性内出血的风险,对死亡率的影响尚不确定.
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:
- 患有大缺血区域的急性缺血性中风 (AIS) 是一个重大的临床挑战.
- 内血管血栓切除术 (EVT) 越来越多地被认为是这种病例的潜在有效治疗方法.
- 随机对照试验 (RCT) 的现有证据需要通过系统审查和元分析不断更新.
研究的目的:
- 更新一个活生生的系统审查和RCT的元分析,将EVT与AIS的医疗管理进行比较.
- 评估EVT在患有大缺血区域的患者的疗效和安全性.
- 评估结果,包括功能独立性,死亡率和症状性内出血 (sICH).
主要方法:
- 在Medline,EMBASE和Cochrane图书馆中对相关RCT进行全面的文献搜索.
- 使用固定效应模型进行元分析,以比较EVT和医疗管理之间的结果.
- 使用Cochrane工具严格评估偏见风险,使用GRADE方法确定证据.
主要成果:
- 六个涉及1876名患者的RCT被纳入了更新的分析.
- 低确定性证据表明,使用EVT改善了功能独立性 (RD 29.9%).
- EVT与sICH风险增加 (RD2.6%) 和死亡率不显著下降 (RD-1.8%) 相关.
结论:
- 更新后的元分析表明,EVT改善了AIS患者的大型心脏病发作中的功能独立性.
- EVT与症状性内出血的风险增加有关.
- 在这个患者群体中,EVT对死亡率的影响仍然不确定,观察到非显著的降低.
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