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动脉内血栓溶解作为急性缺血性中风中血栓切除术的辅助:目前的情况和未来的前景
Adnan I Qureshi1,2, Mohammed M Al-Salihi1, Ibrahim A Bhatti1,2
1Zeenat Qureshi Stroke Institutes, Columbia, Missouri, USA.
概括
动脉内血栓溶解 (IAT) 与机械血栓切除术 (MT) 结合可能改善急性缺血性中风患者的功能结果. 然而,需要进行更大规模的试验来确认益处,并评估症状性脑内出血等风险.
科学领域:
- 神经科学是一个神经科学.
- 干预神经病学 干预神经病学
- 心血管医学 心血管医学
背景情况:
- 近20年来,动脉内血栓溶解 (IAT) 与机械血栓切除术 (MT) 配合用于急性缺血性中风.
- IAT的目的是增强远端动脉和微血管的输液,即使在通过MT进行几乎完全的再通道化后.
研究的目的:
- 审查当前的证据和IAT作为MT辅助的未来影响.
- 进行相关随机对照试验 (RCT) 的系统审查和元分析.
主要方法:
- 一个叙述性综述,包括两个RCT的系统综述和元分析.
- 风险比率 (RRs) 使用固定效应模型进行计算.
- 在全球范围内确定了10个正在进行或计划进行的RCT,其中大多数在中国.
主要成果:
- 之前对观察性研究的元分析显示,IAT的功能独立率高出14%.
- 在目前的RCT分析中 (321名患者),IAT在90天后改善了功能独立性 (mRS 0-1) (RR=1.39).
- 症状性脑内出血 (sICH) 风险在IAT (RR=0.95) 中略有增加,但正在进行的RCT可能缺乏检测较小临床重要差异的能力.
结论:
- 目前的证据表明,IAT可能会改善MT后的功能结果,但需要考虑SICH的风险和研究限制.
- 在日常采用之前,需要进行更大规模的最终RCT来确定IAT的治疗价值和安全性.
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