内血管治疗与非内血管治疗急性缺血性中风与远端中血管封闭:系统性审查和元分析

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Xinyuan Zhang¹, Liyun Wang¹, Zhaohui Chai¹

¹Department of Neurosurgery, The First Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

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|March 12, 2026

概括

内血管治疗 (EVT) 在急性缺血性中风患者中对远端中血管封闭没有益处. EVT增加了出血和死亡的风险,特别是在后部循环封闭时.

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:

内血管治疗 (EVT) 越来越多地用于来自远端中血管封闭的急性缺血性中风.
在这个患者群体中,EVT的疗效和安全性仍然不确定.
这项研究解决了关于EVT在远端中等血管封闭中的确证据缺口.

研究的目的:

系统地审查和对比EVT与非EVT用于急性缺血性中风的研究进行元分析.
评估EVT在患有远端中血管封闭症的患者的疗效和安全性.
评估结果,包括功能独立,症状内出血和死亡率.

主要方法:

按照PRISMA指南进行系统审查和元分析.
从PubMed,Embase和Cochrane图书馆提取的数据,截至2025年2月16日.
包括30项研究 (4项RCT,23个队列,3个病例控制) 涉及9210名患者;分析了优异的结果,功能独立性,症状性内出血和死亡率.

主要成果:

在EVT的优秀结果 (OR 0.98) 或功能独立性 (OR 0.99) 中没有显著的改善.
EVT与症状性内出血 (OR 1.79) 和死亡率 (OR 1.40) 的风险增加有关.
亚组分析:中等前部循环封闭显示出更高的疗效;后部循环封闭具有更高的风险和更低的疗效.

结论:

在没有增加安全风险的情况下,EVT对中等前部循环封闭 (M2,A1) 有效.
对于远端前部循环堵塞,EVT的益处是不确定的.
在后部循环阻塞 (P1,P2,P3) 中的EVT显示出更高的风险和更低的疗效;需要进一步的RCT.

关键词:

前脑动脉的前脑动脉案例控制研究研究.内出血内出血缺血性中风中风进行血栓切除术 (thrombectomy).

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