针对 ASPECTS 0-2 大面积缺血性脑卒中的血管内血栓切除术:随机对照试验的 Meta 分析

IF 2.8 3区 医学 Q2 Medicine Clinical Neuroradiology Pub Date : 2024-04-30 DOI:10.1007/s00062-024-01414-2
Laurens Winkelmeier, Máté Maros, Fabian Flottmann, Christian Heitkamp, Gerhard Schön, Götz Thomalla, Jens Fiehler, Uta Hanning
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引用次数: 0

摘要

目的 随机对照试验(RCT)显示,血管内血栓切除术对急性缺血性卒中大面积梗死(通常定义为阿尔伯塔卒中计划早期 CT 评分(ASPECTS)3-5 分)有治疗效果。方法我们进行了一项系统性回顾和荟萃分析,比较了在急性缺血性前循环卒中伴有大面积梗死(定义为 ASPECTS 为 0-2)时进行血管内血栓切除术与单纯药物治疗的 RCT。主要结果是 90 天改良 Rankin 量表(mRS)的功能转归更好。结果文献研究确定了四项RCT研究,这些研究评估了血管内血栓切除术对大面积心梗的治疗效果,并对ASPECTS为0-2的患者的mRS变化进行了亚组分析。结论该荟萃分析表明,血管内血栓切除术对 ASPECTS 为 0-2 的极低患者有治疗效果,这对使用 ASPECTS 选择大血管闭塞所致急性缺血性卒中的治疗方法提出了挑战。对 RCT 进行个体患者荟萃分析将加强 ASPECTS 为 0-2 的患者的治疗证据。
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Endovascular Thrombectomy for Large Ischemic Strokes with ASPECTS 0–2: a Meta-analysis of Randomized Controlled Trials

Purpose

Randomized controlled trials (RCTs) demonstrated a treatment effect of endovascular thrombectomy in acute ischemic stroke with large infarct, commonly defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 3–5. However, data on endovascular thrombectomy in patients with very low ASPECTS of 0–2 remain scarce.

Methods

We conducted a systematic review and meta-analysis of RCTs comparing endovascular thrombectomy versus medical treatment alone in acute ischemic anterior circulation stroke with very large infarct, defined as ASPECTS of 0–2. The primary outcome was the shift toward better functional outcomes on the 90-day modified Rankin Scale (mRS). Random effects meta-analysis was performed using the generic inverse variance method.

Results

Literature research identified four RCTs which evaluated the treatment effect of endovascular thrombectomy for large infarcts and provided a subgroup analysis of the mRS shift in patients with ASPECTS of 0–2. The pooled analysis showed a significant shift toward better 90-day mRS scores in favor of endovascular thrombectomy (pooled odds ratio, 1.62, 95% confidence interval, 1.29–2.04, P < 0.001).

Conclusion

This meta-analysis suggests a treatment effect of endovascular thrombectomy in specific patients with very low ASPECTS of 0–2, challenging the use of ASPECTS for treatment selection in acute ischemic stroke due to large vessel occlusion. An individual patient meta-analysis of RCTs would strengthen evidence in the treatment of patients with ASPECTS of 0–2.

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来源期刊
Clinical Neuroradiology
Clinical Neuroradiology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
4.90
自引率
3.60%
发文量
0
期刊介绍: Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.
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