Mechanical Thrombectomy for Large Ischemic Stroke A Systematic Review and Meta-analysis

被引：77

作者：

Li, Qi ^{[1
]}

Abdalkader, Mohamad ^{[2
]}

Siegler, James E. ^{[3
]}

Yaghi, Shadi ^{[4
]}

Sarraj, Amrou ^{[5
]}

Campbell, Bruce C. V. ^{[6
]}

Yoo, Albert J. ^{[7
]}

Zaidat, Osama O. ^{[8
]}

Kaesmacher, Johannes ^{[9
]}

Pujara, Deep ^{[5
]}

Nogueira, Raul G. ^{[10
]}

Saver, Jeffrey L. ^{[11
]}

Li, Lei ^{[12
]}

Han, Qin ^{[1
]}

Dai, Yi ^{[1
]}

Sang, Hongfei ^{[13
]}

Yang, Qingwu ^{[14
,15
]}

Nguyen, Thanh N. ^{[16
]}

Qiu, Zhongming ^{[1
]}

机构：

[1] Chinese Peoples Liberat Army, Hosp 903, Dept Neurol, Hangzhou, Peoples R China

[2] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Dept Radiol, Boston, MA, Brazil

[3] Cooper Univ Hosp, Cooper Neurol Inst, Camden, NJ USA

[4] Brown Univ, Rhode Isl Hosp, Providence, RI USA

[5] Case Western Reserve Univ, Univ Hosp Cleveland Med Ctr, Cleveland, OH USA

[6] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Med & Neurol, Parkville, Vic, Australia

[7] Texas Stroke Inst, Ft Worth, TX USA

[8] Bon Secours Mercy Hlth St Vincent Hosp, Neurosci & Stroke Program, Toledo, OH USA

[9] Univ Bern, Univ Inst Diagnost & Intervent Neuroradiol, Bern Univ Hosp, Inselspital, Bern, Switzerland

[10] Univ Pittsburgh, Med Ctr, Neurol & Neurosurg, Pittsburgh, PA, India

[11] Univ Calif Los Angeles, Neurol, Los Angeles, CA USA

[12] Harbin Med Univ, Affiliated Hosp 2, Neurol, Harbin, Peoples R China

[13] Zhejiang Univ, Affiliated Hangzhou Peoples Hosp 1, Sch Med, Neurol, Hangzhou, Peoples R China

[14] Army Med Univ, Xinqiao Hosp, Neurol, Chongqinq, Peoples R China

[15] Army Med Univ, Affiliated Hosp 2, Chongqinq, Peoples R China

[16] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Dept Neurol, Boston, MA, Brazil

来源：

NEUROLOGY | 2023年 / 101卷 / 09期

关键词：

STROKE; THERAPY; GUIDELINES; MANAGEMENT; SOCIETY; IMPACT; JAPAN; CORE;

D O I：

10.1212/WNL.0000000000207536

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and ObjectivesThere is growing evidence for endovascular thrombectomy (EVT) in patients with large ischemic core infarct and large vessel occlusion (LVO). The objective of this study was to compare the efficacy and safety of EVT vs medical management (MM) using a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs).MethodsWe searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to mechanical thrombectomy for large ischemic core from inception until February 10, 2023. The primary outcome was independent ambulation (modified Rankin Scale [mRS] 0-3). Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. The quality of articles was evaluated through the Cochrane risk assessment tool and the Newcastle-Ottawa Scale. This study was registered in PROSPERO (CRD42023396232).ResultsA total of 5,395 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded by review of the title, abstract, and full text. Finally, 3 RCTs and 10 cohort studies met the inclusion criteria. The RCT analysis showed that EVT improved the 90-day functional outcomes of patients with large ischemic core with high-quality evidence, including independent ambulation (mRS 0-3: RR 1.78, 95% CI 1.28-2.48, p < 0.001) and functional independence (mRS 0-2: RR 2.59, 95% CI 1.89-3.57, p < 0.001), but without significantly increasing the risk of symptomatic intracranial hemorrhage (sICH: RR 1.83, 95% CI 0.95-3.55, p = 0.07) or early mortality (RR 0.95, 95% CI 0.78-1.16, p = 0.61). Analysis of the cohort studies showed that EVT improved functional outcomes of patients without an increase in the incidence in sICH.DiscussionThis systematic review and meta-analysis indicates that in patients with LVO stroke with a large ischemic core, EVT was associated with improved functional outcomes over MM without increasing sICH risk. The results of ongoing RCTs may provide further insight in this patient population.

引用

页码：E922 / E932

页数：11

共 45 条

[1] Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy [J].

Abdalkader, Mohamad ;

Siegler, James E. ;

Lee, Jin Soo ;

Yaghi, Shadi ;

Qiu, Zhongming ;

Huo, Xiaochuan ;

Miao, Zhongrong ;

Campbell, Bruce C. V. ;

Nguyen, Thanh N. .

JOURNAL OF STROKE, 2023, 25 (01) :55-71

[2] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Acute and Interventional Treatments [J].

Campbell, Bruce C. V. ;

Hill, Michael D. ;

Nguyen, Thanh N. ;

Broderick, Joseph P. .

STROKE, 2023, 54 (02) :591-594

[5] Patients With Ischemic Core ≥70 m Within 6 h of Symptom Onset May Still Benefit From Endovascular Treatment [J].

Chen, Zhicai ;

Zhang, Ruiting ;

Zhou, Ying ;

Gong, Xiaoxian ;

Zhang, Meixia ;

Shi, Feina ;

Yu, Xinfeng ;

Lou, Min .

FRONTIERS IN NEUROLOGY, 2018, 9

[6] Patients may be right: Clinical research should be designed in their best medical interest [J].

Darsaut, T. E. ;

Collins, J. ;

Raymond, J. .

NEUROCHIRURGIE, 2023, 69 (01)

[7] Endovascular Thrombectomy for Low ASPECTS Large Vessel Occlusion Ischemic Stroke: A Systematic Review and Meta-Analysis [J].

Diestro, Jose Danilo B. ;

Dmytriw, Adam A. ;

Broocks, Gabriel ;

Chen, Karen ;

Hirsch, Joshua A. ;

Kemmling, Andre ;

Phan, Kevin ;

Bharatha, Aditya .

CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES, 2020, 47 (05) :612-619

[8] Indications for the Performance of Intracranial Endovascular Neurointerventional Procedures A Scientific Statement From the American Heart Association [J].

Eskey, Clifford J. ;

Meyers, Philip M. ;

Nguyen, Thanh N. ;

Ansari, Sameer A. ;

Jayaraman, Mahesh ;

McDougall, Cameron G. ;

DeMarco, J. Kevin ;

Gray, William A. ;

Hess, David C. ;

Higashida, Randall T. ;

Pandey, Dilip K. ;

Pena, Constantino ;

Schumacher, Hermann C. .

CIRCULATION, 2018, 137 (21) :E661-E689

[9] A randomized pragmatic care trial on endovascular acute stroke interventions (EASI): criticisms, responses, and ethics o integrating research and clinical care [J].

Fahed, Robert ;

Finitsis, Stefanos ;

Khoury, Naim ;

Deschaintre, Yan ;

Daneault, Nicole ;

Gioia, Laura ;

Jacquin, Gregory ;

Odier, Celine ;

Poppe, Alexande Y. ;

Weill, Alain ;

Roy, Daniel ;

Darsaut, Tim E. ;

Nguyen, Thanh N. ;

Raymond, Jean .

TRIALS, 2018, 19

[10] Improved Prospects for Thrombectomy in Large Ischemic Stroke [J].

Fayad, Pierre .

NEW ENGLAND JOURNAL OF MEDICINE, 2023, 388 (14) :1326-1328

← 1 2 3 4 5 →