Stead Latha G, Gilmore Rachel M, Bellolio M Fernanda, Rabinstein Alejandro A, Decker Wyatt W
Department of Emergency Medicine, Division of Research, Generose Bldg, Ste G-410, 200 First St SW, Rochester, MN 55905, USA.
Arch Neurol. 2008 Aug;65(8):1024-30. doi: 10.1001/archneur.65.8.1024.
We conducted a systematic review and meta-analysis of mechanical thrombectomy in the treatment of ischemic stroke and assessed factors for technical and clinical success and survival. We searched the literature using MEDLINE and EMBASE for January 1, 2000, through March 1, 2006. Studies were limited to those in human beings; there were no language or study design restrictions. Validity assessment was performed using the Newcastle-Ottawa Scale. The pooled cohort was compared with a historical cohort matched for sex, age, and National Institutes of Health Stroke Survey score. The search yielded 114 publications. Two authors determined inclusibility (interrater agreement, kappa = 0.94). Mean preprocedure National Institutes of Health Stroke Survey score was 20.4. The middle cerebral artery (36%) and the posterior circulation (38%) were the most frequently occluded areas. The clot was accessible in 85% of the patients. Hemorrhage occurred in 22% of the patients. Of 81 patients with concurrent thrombolysis, 18.5% had hemorrhage compared with 27.3% of 66 patients without thrombolysis (P = .21). Of the 126 patients with accessible clots, 36% had a good modified Rankin score (<or=2) and 29% died; in patients with inaccessible clots, 24% had a good modified Rankin score and 38% died. Factors associated with clinical success were younger age (P = .001) and lower National Institutes of Health Stroke Survey score at admission to the hospital (P = .001). Compared with a matched cohort, patients who received mechanical intervention were 14.8 times more likely to have a good modified Rankin score (95% confidence interval, 4.4-50.0; P < .001). Percutaneous mechanical embolectomy in the treatment of acute ischemic stroke is feasible and seems to provide an option for some patients seen after the interval for administration of intravenous tissue plasminogen activator therapy has elapsed.
我们对机械取栓治疗缺血性卒中进行了系统评价和荟萃分析，并评估了技术成功、临床成功及生存的相关因素。我们使用MEDLINE和EMBASE检索了2000年1月1日至2006年3月1日的文献。研究限于人类研究；无语言或研究设计限制。使用纽卡斯尔-渥太华量表进行效度评估。将汇总队列与按性别、年龄和美国国立卫生研究院卒中量表评分匹配的历史队列进行比较。检索得到114篇出版物。两名作者确定纳入标准（评分者间一致性，kappa = 0.94）。术前美国国立卫生研究院卒中量表平均评分为20.4。大脑中动脉（36%）和后循环（38%）是最常发生闭塞的区域。85%的患者血栓可及。22%的患者发生出血。在81例同时进行溶栓治疗的患者中，18.5%发生出血，而66例未进行溶栓治疗的患者中这一比例为27.3%（P = 0.21）。在126例血栓可及的患者中，36%的患者改良Rankin量表评分良好（≤2分），29%的患者死亡；在血栓不可及的患者中，24%的患者改良Rankin量表评分良好，38%的患者死亡。与临床成功相关的因素为年龄较小（P = 0.001）和入院时美国国立卫生研究院卒中量表评分较低（P = 0.001）。与匹配队列相比，接受机械干预的患者改良Rankin量表评分良好的可能性高14.8倍（95%置信区间，4.4 - 50.0；P < 0.001）。经皮机械取栓治疗急性缺血性卒中是可行的，似乎为一些错过静脉注射组织纤溶酶原激活剂治疗时间窗的患者提供了一种选择。
