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血栓切除术用于超过24小时的缺血性中风:一个元分析
Hao-Tse Chiu1,2, Po-Huang Chen3, Yen-Yue Lin1,2
1Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, National Defense Medical Center, No. 168, Zhongxing Rd., Longtan Dist., Taoyuan 325208, Taiwan.
Life (Basel, Switzerland)
|April 26, 2025
概括
在24小时以后的缺血性中风内血管治疗显示出与24小时内治疗相似的结果. 这表明在中风患者中延长治疗窗口的潜在好处,尽管需要更多的研究.
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:
- 大血管封闭 (LVO) 中风的内血管治疗 (EVT) 在6-24小时内确定的好处 (DEFUSE-3,DAWN研究).
- 在24小时窗口之后出现的缺血性中风患者的EVT的有效性存在不确定性.
- 需要对不同时间窗口中的EVT结果进行比较分析.
研究的目的:
- 评估和比较24小时以后因缺血性中风接受EVT的患者的预后,与24小时内进行的预后.
- 评估两个治疗组之间功能独立,再输血,出血和死亡率的差异.
主要方法:
- 在2024年2月1日之前对PubMed,Cochrane和Embase数据库进行系统审查.
- 包括七项队列研究,其中6137名参与者接受了EVT.
- 对于关键结果指标的95%置信区间 (CI) 的几率比率 (OR) 的计算.
主要成果:
- 在功能独立方面没有观察到显著差异 (OR1.06,95% CI:0.51-2.19).
- 成功再输血 (OR 1.03,95% CI:0.72-1.48) 和内出血 (任何:OR 0.88,95% CI:0.64-1.21;有症状:OR 0.76,95% CI:0.41-1.40) 的比率相似.
- 90天死亡率在各组之间是可比的 (OR 1.32,95% CI:0.55-3.19);试验的序列分析是不确定的.
结论:
- 在24小时以后的缺血性中风中,EVT的结果与24小时内的治疗相比,在功能独立性,再输血,出血和死亡率方面具有相似的结果.
- 对于24小时后出现缺血性中风的患者来说,EVT可能是一个可行的选择.
- 进一步的随机对照试验和额外的队列研究是有必要的,以巩固这些发现.
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