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内血管治疗与24小时以后出现的缺血性中风的医疗管理:系统性审查和元分析
Derrek Schartz1, Rohin Singh2, Nathaniel Ellens2
1Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, United States; Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States.
Clinical neurology and neurosurgery
|July 4, 2024
概括
与最佳医疗管理 (MM) 相比,内血管治疗 (EVT) 显著改善功能独立性,并降低晚期缺血性中风患者的死亡率. 进一步的研究是有必要的,以扩大EVT治疗窗口.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 血管外科 血管外科
背景情况:
- 超过24小时的缺血性中风的管理是具有挑战性的.
- 晚期视窗缺血性中风的最佳治疗策略尚不清楚.
研究的目的:
- 为了比较内血管治疗 (EVT) 与24小时后出现的缺血性中风的最佳医疗管理 (MM) 的疗效和安全性.
- 评估结果,包括功能独立,死亡率和症状性内出血.
主要方法:
- 系统的文献综述和比较的元分析.
- 包括五项研究,包括704名患者 (461名EVT,243名MM).
- 随机效应模型用于结果的定量合成.
主要成果:
- EVT显著增加了功能独立性 (34.6%与15.9%,P < 0.00001).
- 症状性内出血的发病率在两组之间没有显著差异 (6.8%对2.8%,P=0.26).
- EVT与显著降低90天死亡率 (24.5%与33.1%,P=0.0003) 相关.
结论:
- 电动脑电脑治疗在功能独立方面具有显著的优势,并减少了选择晚期视窗缺血性中风患者的死亡率.
- 这些发现支持进一步调查延长EVT治疗窗口超过24小时.
- 需要进行随机临床试验来证实这些结果.
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