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在成功的内血管再输液后辅助血栓抑制剂:随机对照试验的系统审查和元分析

Mohamed F Doheim¹, Mahmoud H Mohammaden², Ammar Jumah²

¹UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Annals of neurology

|August 13, 2025

概括

血管内血栓切除术 (EVT) 后的动脉内血栓溶解 (IAT) 在大血管封闭性中风 (LVOS) 中改善了优秀的功能结果. 这次元分析发现IAT安全,没有增加出血或死亡风险,特别是在前部循环中风中.

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:

大血管封闭性中风 (LVOS) 在实现有利的患者结局方面存在重大挑战.
动脉内血栓溶解 (IAT) 在LVOS中作为内血管血栓切除 (EVT) 的辅助作用受到争论,最近的随机对照试验 (RCT) 提供了相互矛盾的证据.

研究的目的:

评估IAT作为EVT的附加疗法的有效性和安全性,用于诊断为LVOS的患者.
评估IAT在成功EVT后对功能结果和安全参数的影响.

主要方法:

在2015年1月至2025年2月期间发表的6项RCT进行了系统的元分析,通过全面的数据库搜索确定了这些RCT.
主要结局是卓越的功能结局 (修改的兰金尺度 (mRS) 0-1在90天),次要结局包括功能独立性 (mRS 0-2),症状性内出血 (sICH) 和90天死亡率.
统计分析利用几率比率 (OR) 与95%置信区间 (CI) 来比较IAT和对照组之间的结果.

主要成果:

IAT显著提高了在90天 (OR=1.47,p<0.001) 实现优异功能结果 (mRS 0-1) 的几率,特别是在前循环LVOS (OR=1.48,p<0.001) 中.
在血栓溶解药物中,高体和薄体与良好的结局的关联最强.
没有观察到SICH (OR=1.15,p=0.51) 或90天死亡率 (OR=1.00,p=0.99) 的显著增加,这支持了IAT的安全性.

结论:

成功EVT后的IAT是一种有效的策略,可以提高LVOS患者的优良功能结果,特别是那些前部循环受影响的患者.
IAT的安全性是由缺乏增加的SICH或死亡率所支持的,无论血栓解压剂或中风的位置如何.
进一步的研究可能会澄清IAT在后循环LVOS中的特定益处.

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