缺血性中风与大心脏病核心的内血管治疗:随机对照试验的更新系统审查和元分析
Marco Longoni1, Sebastiano Giacomozzi2, Leonardo Pantoni3
1Department of Neurology and Stroke Unit, Bufalini Hospital, AUSLRomagna, Cesena, Italy. marco.longoni@auslromagna.it.
概括
大型心脏病发作的大型血管封闭性中风的内血管治疗 (EVT) 显著改善功能结果并降低死亡率. 虽然症状性内出血风险略有增加,但EVT与单独的最佳医疗治疗相比,提供更好的恢复机会.
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:
- 内血管治疗 (EVT) 是急性缺血性中风的标准,具有大血管封闭 (LVO) 和ASPECTS≥6.
- 对于LVO中风患者的大型心脏梗塞的EVT存在有限的数据 (ASPECTS 0-5).
- 这次系统性审查和元分析评估了EVT在这个特定患者群体中的疗效.
研究的目的:
- 系统地审查和元分析对EVT的随机对照试验 (RCT) 与对LVO中风患者的大型心脏梗塞的最佳医疗疗 (BMT).
- 评估EVT对90天后功能独立,残疾和死亡率的影响.
- 评估安全结果,包括症状性内出血 (sICH) 和死亡率.
主要方法:
- 遵守PRISMA系统审查和元分析指南.
- 包括7个RCT,包括1964名患者.
- 主要终点:90天后功能独立 (修改的兰金尺度[mRS]<3). 二级终点包括中度残疾 (mRS < 4),优异的结果 (mRS < 2) 和轮班分析. 安全结果是SICH和3个月死亡率.
主要成果:
- 与BMT相比,EVT显著增加了功能独立 (19.4%与8%相比;OR=2.72) 和中度结果 (OR=2.00).
- 优秀的结果 (OR=1.54) 和整体功能改善 (转变分析OR=1.59) 也显著高于EVT.
- 症状性内出血 (sICH) 随着EVT略有增加 (OR=1.63),但3个月死亡率显著降低 (31%对37.1%;OR=0.76).
结论:
- EVT加BMT显著改善了LVO中风患者的大型心脏病发作的功能结果.
- 在这种患者群体中,EVT显示3个月死亡率显著降低.
- 尽管sICH略有增加,但EVT为精选的中风患者提供了有利的风险-益处概况.
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