Ali Mortezaei , Mohammadreza Alizadeh , Mohammad Mirahmadi Eraghi , Sogand Sheikholeslami , Taimur Hasan , Ramin Shahidi , Visish M. Srinivasan , Jan-Karl Burkhardt , Redi Rahmani
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引用次数: 0
Abstract
Background
Reducing the stroke time metric in patients with stroke who underwent thrombectomy is associated with good functional recovery. We compared direct transfer to angiosuite (DTAS) vs conventional workup (CWU) in patients who underwent endovascular treatment due to large vessel occlusion (LVO).
Methods
A systematic search was conducted in four electronic databases. The continuous outcomes were analyzed using the standardized mean difference (SMD) and 95 % CI, while the binary outcomes were analyzed using the odds ratio (OR) and 95 % confidence interval (CI).
Results
We included a total of 3145 patients, which 1168 patients were in DTAS group and 1977 were in CWU group. DTAS showed a significantly higher likelihood of 90-day mRS0-1 (OR 1.6, p = 0.002) and mRS0-2 (OR 1.47, p < 0.0001), successful reperfusion (OR 1.53, 95 % CI 1.1 to 2.1, p = 0.0122), and lower door-to-puncture (SMD −4.36, 95 % CI −7.4 to −1.3, p = 0.0096) than CWU. There was no significant difference between the two triage protocols in 90-day mortality (OR 0.98, 95 % CI 0.6 to 1.64, p = 0.94) and symptomatic intracranial hemorrhage (OR 0.78, p = 0.14). The proportion of patients who were triaged to DTAS with non-LVO on diagnostic angiography in angiosuite was 5.76 % (95 % CI 1.8 % to 11.4 %). There was a significant difference between randomized trials versus observational studies in 90-day mRS0-2 (OR 1.91 vs 1.16, p = 0.0042), 90-day mortality (OR 0.62 vs 1.27, p = 0.12), and door-to-puncture time (SMD −1.25 vs −5.53, p = 0.027).
Conclusion
DTAS is a feasible, safe, and cost-effective triage approach for managing patients with acute stroke due to LVO.
背景：减少接受血栓切除术的卒中患者的卒中时间指标与良好的功能恢复相关。我们比较了由于大血管闭塞（LVO）而接受血管内治疗的患者的直接血管移植（DTAS）与常规检查（CWU）。方法系统检索4个电子数据库。连续结局采用标准化平均差（SMD）和95% CI进行分析，二元结局采用优势比（OR）和95%置信区间（CI）进行分析。结果共纳入3145例患者，其中DTAS组1168例，CWU组1977例。DTAS显示90天mRS0-1 （OR 1.6, p = 0.002）和mRS0-2 (OR 1.47, p <；0.0001)，再灌注成功（OR 1.53, 95% CI 1.1 ~ 2.1, p = 0.0122），穿刺门径（SMD - 4.36, 95% CI - 7.4 ~ - 1.3, p = 0.0096）较CWU低。两种分诊方案在90天死亡率（OR 0.98, 95% CI 0.6 ~ 1.64, p = 0.94）和症状性颅内出血（OR 0.78, p = 0.14）方面无显著差异。在血管造影诊断中被分类为DTAS合并非lvo的患者比例为5.76% （95% CI为1.8%至11.4%）。随机试验与观察性研究在90天mRS0-2 （OR 1.91 vs 1.16, p = 0.0042）、90天死亡率（OR 0.62 vs 1.27, p = 0.12）和穿刺时间（SMD - 1.25 vs - 5.53, p = 0.027）方面存在显著差异。结论dtas是治疗LVO急性脑卒中的一种可行、安全、经济的分诊方法。
期刊介绍：
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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