Endovascular thrombectomy after acute ischemic stroke of the basilar artery: a meta-analysis of four randomized controlled trials

被引：27

作者：

Adusumilli, Gautam ^{[1
]}

Kobeissi, Hassan ^{[2
]}

Ghozy, Sherief ^{[2
]}

Hardy, Nicole ^{[3
]}

Kallmes, Kevin M. ^{[3
]}

Hutchison, Kristen ^{[3
]}

Kallmes, David F. ^{[2
]}

Brinjikji, Waleed ^{[2
]}

Albers, Gregory W. ^{[4
]}

Heit, Jeremy J. ^{[5
]}

机构：

[1] Massachusetts Gen Hosp, Dept Radiol, Boston, MA USA

[2] Mayo Clin Minnesota, Dept Radiol, Rochester, MN USA

[3] Nested Knowledge Inc, St Paul, MN USA

[4] Stanford Univ, Dept Neurol, Stanford, CA USA

[5] Stanford Univ, Dept Radiol, Neuroradiol & Neurointervent Div, Stanford, CA 94305 USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / E3期

关键词：

Stroke; Thrombectomy; Thrombolysis; Posterior fossa; Intervention; RISK-FACTORS; THERAPY;

D O I：

10.1136/jnis-2022-019776

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

BackgroundPrevious randomized controlled trials (RCTs) and meta-analyses were underpowered to demonstrate the superiority of endovascular thrombectomy (EVT) over medical therapy (MEDT) in the treatment of acute ischemic stroke due to large vessel occlusion of the posterior circulation (PC-LVO). We performed an updated systematic review and meta-analysis after the publication of the BAOCHE and ATTENTION trials to determine whether EVT can benefit patients presenting with PC-LVO. MethodsUsing Nested Knowledge, we screened literature for RCTs on EVT in PC-LVO. The primary outcome was 90-day modified Rankin Scale (mRS) score 0-3, and secondary outcomes included 90-day mRS score 0-2, 90-day mortality, and rate of symptomatic intracranial hemorrhage (sICH). A random-effects model was used to compute rate ratios (RRs) and their corresponding 95% confidence intervals (CIs). ResultsFour RCTs with 988 patients, 556 patients in the EVT arm and 432 patients in the MEDT arm, were included in the meta-analysis. EVT resulted in significantly higher rates of mRS score 0-3 (RR=1.54; 95% CI 1.16 to 2.04; P=0.002) and functional independence (RR=1.83; 95% CI 1.08 to 3.08; P=0.024), and lower rates of mortality (RR=0.76; 95% CI 0.65 to 0.90; P=0.002) at 90-day follow-up compared with MEDT alone. However, EVT patients had higher rates of sICH (RR=7.48; 95% CI 2.27 to 24.61; P<0.001). ConclusionsEVT conferred significant patient benefit over MEDT alone in the treatment of PC-LVO. Future studies should better define patients for whom EVT is futile and determine factors that contribute to higher rates of sICH.

引用

页码：e446 / e451

页数：6

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