在TAVI中的哨兵大脑保护系统:随机和倾向匹配研究的更新元分析
Márcio Braite1, Natanael de Paula Portilho2, Lara Barbosa de Souza Moura Canas Lara3
1Hospital of Love, Barretos, São Paulo, Brazil.
概括
哨兵脑栓塞保护 (CEP) 系统在跨导管大动脉植入 (TAVI) 期间没有减少中风. 然而,综合分析显示,它降低了30天死亡率和急性损伤 (AKI).
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 神经外科 神经外科
背景情况:
- 脑卒中是通过导管的大动脉植入术 (TAVI) 后的一个重大并发症.
- 哨兵脑栓塞保护 (CEP) 系统旨在减少TAVI期间的栓塞碎片.
- 在预防中风方面,Sentinel CEP系统的临床有效性尚未得到充分证实.
研究的目的:
- 评估Sentinel CEP系统对TAVI患者中风和相关结果的影响.
- 综合来自随机对照试验 (RCT) 和倾向得分匹配 (PSM) 研究的证据.
主要方法:
- 在PubMed,Embase和Cochrane数据库中进行了系统的文献搜索.
- 包括比较TAVI与Sentinel CEP系统和没有Sentinel CEP系统的研究.
- 使用随机效应模型进行了聚合分析,以计算各种结果的风险比率 (RR) 和95%置信区间 (CI).
主要成果:
- 分析了8项涉及33111名患者的研究 (5项RCT,3项PSM).
- 使用Sentinel CEP与显著降低30天死亡率 (RR 0.75) 和急性损伤 (AKI) (RR 0.90) 相联系.
- 没有观察到周围手术缺血性中风,总中风,住院死亡率,复合死亡或中风或主要血管并发症的显著减少.
结论:
- 在对TAVI患者的综合分析中,Sentinel CEP系统显示了30天死亡率和AKI的降低.
- 该系统并没有显著降低中风率.
- 需要进一步的研究,特别是在高风险的TAVI人群中,因为在RCT中观察到的益处缺乏.
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