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由于中等血管封闭而导致的急性缺血性中风的内血管治疗:通过元分析进行系统性审查

Farsana Mustafa¹, Baikuntha Panigrahi², Partha Haldar³

¹Department of Neurology, All India Institute of Medical Scienceshttps://ror.org/02dwcqs71, New Delhi, India.

The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques

|November 13, 2025

概括

由于中等血管封闭 (MeVO) 导致的急性缺血性中风 (AIS) 的内血管治疗 (EVT) 不能改善患者的结果. 与最好的医疗治疗相比,EVT与症状性内出血和严重不良事件的风险增加有关.

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:

中等血管封闭 (MeVO) 占急性缺血性中风 (AIS) 的很大一部分.
由于MeVO导致的AIS的内血管治疗 (EVT) 的疗效和安全性仍然不确定,最近的随机对照试验 (RCT) 产生了中性结果.
这一元分析综合了证据,以澄清EVT在MeVO中的作用.

研究的目的:

评估EVT在改善MeVO导致AIS患者的功能结果方面的综合疗效.
评估EVT的安全性,特别是症状性内出血 (sICH) 和严重不良事件 (SAE) 的风险.
提供基于证据的见解,用于管理AIS与MeVO的临床决策.

主要方法:

进行了对两个相关RCT (DISTAL和ESCAPE-MeVO) 的系统审查和元分析.
总共有1073名参与者被纳入分析.
主要结局:卓越的功能结局 (修改的兰金得分 (mRS) 0-1在90天). 二次结局:mRS 0-2,SICH,以及死亡率.

主要成果:

在EVT和最佳医疗治疗 (BMT) 之间,在优良的功能性结果 (mRS 0-1) 中没有发现显著差异 (RR: 0.95,95% CI: 0.81-1.10).
同样,对于mRS 0-2的功能性结果也没有发现显著差异 (RR:0.98,95% CI:0.88-0.09).
与BMT相比,EVT与sICH (RR: 2.39,95%CI: 1.26-4.53) 和SAE (RR: 1.32,95%CI: 1.11-1.56) 的风险明显更高.

结论:

由于MeVO导致的AIS的内血管治疗与最佳医疗治疗相比,在90天内不会产生更好的功能结果.
在这种患者群体中,EVT与症状性内出血和严重不良事件的风险增加有关.
试验的顺序分析证实了这些发现,表明EVT对MeVO中风没有好处,并且可能有害.

关键词:

一个远距离的.逃跑-我的世界这是最好的医疗治疗.血管内治疗血管内治疗中等血管的封闭.

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