针对急性脊柱塞的内血管治疗 (VERITAS):系统性审查和个体患者数据的元分析
Raul G Nogueira1, Tudor G Jovin2, Xinfeng Liu3
1UPMC Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Lancet (London, England)
|December 14, 2024
概括
血管内治疗显著改善了基底动脉封闭性中风患者的功能结果,增加了2. 5倍的良好结果的可能性. 这种治疗减少了残疾和死亡率,尽管出血的风险更高.
科学领域:
- 神经学
- 干预心脏病学
- 公共卫生
背景情况:
- 基础动脉阻塞 (BAO) 中风治疗的结果不一致.
- 内血管治疗 (EVT) 和标准医疗 (SMT) 的疗效需要进一步研究.
- 单个患者数据的元分析可以澄清EVT在BAO中的作用.
研究的目的:
- 通过随机对照试验 (RCT) 汇集患者层面的数据.
- 评估EVT与SMT相比的安全性和有效性.
- 在预先指定的患者小组中探索治疗效益.
主要方法:
- 在VERITAS研究中对RCT进行了系统审查和元分析.
- 包含的试验招募了脊柱基础性缺血性中风患者 (2010年1月至2023年9月).
- 主要结局:90天的良好功能状态 (修改的兰金尺度[mRS] 0-3). 安全性结果:症状性内出血和90天死亡率.
主要成果:
- 包括四项试验 (988名患者),其中91%的患者在发病后12小时内接受治疗.
- EVT显著增加了良好的功能状态 (mRS 0- 3) (45%对30%; aOR 2. 41; p< 0. 0001).
- EVT 减少了残疾和死亡率 (36% 与 45% 相比; aOR 0. 60; p< 0. 0001),但增加了症状性内出血 (5% 与 < 1%; aOR 11. 98; p< 0. 0001).
结论:
- 对于中度至严重的BAO,VERITAS支持EVT,增加了2. 5倍的良好结果.
- 尽管增加了出血风险,但EVT显著降低了残疾和死亡率.
- 对于轻微的中风严重程度或广泛的心脏病发作,EVT的益处是不确定的,但对广泛的患者来说是显著的.
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