Efficacy and Safety of Initiating Intravenous Glycoprotein IIb/IIIa Inhibitors Before Acute Stent Implantation in Patients with Cerebral Infarction: A Systematic Review and Meta-Analysis

IF 2.1 4区医学 Q3 CLINICAL NEUROLOGY World neurosurgery Pub Date : 2025-06-01 Epub Date: 2025-03-31 DOI:10.1016/j.wneu.2025.123955

Wulan Yang , Qingmei Han , Aa Ruhan Bai , Ya Na , Yun Qing

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Abstract

Objective

To evaluate the safety and efficacy of initiating glycoprotein IIb/IIIa inhibitor (GPI) infusion prior to acute intracranial artery stent implantation.

Methods

We performed a meta-analysis using RevMan software to calculate the pooled risk ratio and 95% confidence intervals (CIs) to assess efficacy and safety.

Results

The systematic review and meta-analysis included 7 studies involving 1156 patients who underwent acute stent implantation. 1) Efficacy outcomes: GPI not significantly improved favorable 90-day functional outcome (P = 0.05, I² = 0%, CI 1.14[1.00–1.30]). GPI significantly reduced perioperative stent thrombosis (P < 0.00001, I² = 0%, CI 0.21[0.1–0.43]), the results did not indicate a significant advantage of GPI in recanalization (P = 0.53, I² = 0%, CI 1.01[0.98–1.04]). 2) The findings showed that GPI did not result in a higher incidence of spontaneous intracerebral hemorrhage (P = 0.76, I² = 0%, CI 0.93[0.59–1.48]), GPI not significantly improved favorable 90-day functional outcome in patients after stenting (P = 0.05, I² = 0%, CI 1.14[1.00–1.30]). 3) Subgroup analysis: No statistically significant differences in recanalization (Thrombolysis in Cerebral Infarction ≥2b) (P = 0.9, I² = 0%, CI 1.00[0.95–1.06]) and perioperative spontaneous intracerebral hemorrhage (P = 0.77, I² = 5%, CI 1.50[1.01–2.22]) between the two groups, GPI was associated with a significant reduction in the incidence of perioperative stent thrombosis (P = 0.0003, I² = 0%, CI 0.22[0.09–0.50]) and demonstrated an improvement in favorable clinical outcomes at 90 days after acute carotid stenting (P = 0.04, I² = 1%, P= 0.001, CI 1.23[0.98–1.54]).

Conclusions

The use of intravenous GPI before acute stent implantation can reduce perioperative intravascular thrombosis but does not improve patient outcomes at 90 days. The use of intravenous GPI before carotid acute stenting may enhance 90-day outcomes and reduce perioperative stent thrombosis.

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脑梗死患者急性支架置入术前静脉注射糖蛋白IIb/IIIa抑制剂的疗效和安全性：一项系统综述和荟萃分析

目的：评价急性颅内动脉支架植入术前灌注GPI的安全性和有效性。方法：采用RevMan软件进行meta分析，计算合并风险比（RR）和95%置信区间（CI），评估疗效和安全性。结果：系统评价和荟萃分析纳入了7项研究，涉及1156例急性支架植入术患者。1. 疗效结果：GPI未显著改善90天功能预后（P=0.05, I2=0%, CI 1.14[1.00-1.30]）。GPI可显著降低围手术期支架血栓形成（P2=0%, CI 0.21[0.1-0.43]），结果表明糖蛋白抑制剂（GPI）在再通方面没有显著优势（P=0.53, I2=0%, CI 1.01[0.98-1.04]）。2. 研究结果显示，GPI并未导致自发性脑出血（SICH）发生率增高（P=0.76, I2=0%, CI 0.93[0.59-1.48]）， GPI并未显著改善支架植入术后患者90天的良好功能结局（P=0.05, I2=0%, CI 1.14[1.00-1.30]）。3. 亚组分析：两组再通率（TICI≥2b）（P=0.9, I2=0%, CI 1.00[0.95 ~ 1.06]）和围手术期siich （P=0.77, I2=5%, CI 1.50[1.01 ~ 2.22]）无统计学差异，GPI与围手术期支架血栓发生率显著降低相关（P=0.0003, I2=0%, CI 0.22[0.09 ~ 0.50]），急性颈动脉支架置入术后90天的良好临床结果改善相关（P=0.04, I2=1%， P= 0.001, CI 1.23[0.98 ~ 1.54]）。结论：急性支架植入术前静脉注射GPI可减少围术期血管内血栓形成，但不能改善患者90天的预后。颈动脉急性支架植入术前静脉注射GPI可提高90天的预后并减少围手术期支架血栓形成。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS