Oregon Health and Science University, Portland, OR, USA.
J Neurointerv Surg. 2011 Jun;3(2):151-5. doi: 10.1136/jnis.2010.002766. Epub 2010 Dec 8.
Randomized clinical trials supporting the use of intra-arterial administration of thrombolytics (IAT) for the treatment of stroke due to middle cerebral artery (MCA) occlusion have been positive on some, but not all, endpoints. A meta-analysis was performed to estimate with more precision the effect of IAT on several key clinical endpoints.
All randomized trials of IAT in the treatment of MCA stroke were identified by PUBMED search and by hand search of potentially relevant references. Trial methodologies were assessed for compatibility in study protocols and statistical analysis. A meta-analysis was performed evaluating the effect of IAT on functional outcome at 90 days and symptomatic intracranial hemorrhage (SICH) within 24 h.
Three trials met the criteria for the meta-analysis. IAT treated patients were significantly more likely to have a modified Rankin scale (mRS) ≤ 1 (31% vs 20%, OR 2.0, 95% CI 1.2 to 3.4, p=0.01); mRS ≤ 2 (43% vs 31%, OR 1.9, 95% CI 1.2 to 3.0, p=0.01); and NIH Stroke Scale score 0 or 1 (23% vs 12%, OR 2.4, 95% CI 1.3 to 4.4, p=0.007) at the 90 day follow-up. There was no effect on mortality at 90 days (20% vs 19%, OR 0.84, 95% CI 0.5 to 1.5). The risk of SICH was significantly increased in the active treatment arms (11% vs 2%, OR 4.6, 95% CI 1.3 to 16, p=0.02).
Our meta-analysis demonstrates that all standard functional endpoints for stroke trials were substantially improved in the active treatment arms. Despite an increased risk of SICH, there was no effect on mortality. These results support endovascular treatment of acute ischemic stroke due to MCA occlusion with intra-arterial thrombolytics.
支持使用动脉内溶栓剂（IAT）治疗大脑中动脉（MCA）闭塞引起的中风的随机临床试验在一些但不是所有终点上均为阳性。进行了荟萃分析，以更精确地估计 IAT 对几个关键临床终点的影响。
通过 PUBMED 搜索和对手头相关参考文献的搜索，确定了所有 IAT 治疗 MCA 中风的随机试验。评估了试验方法学在研究方案和统计分析方面的兼容性。进行了荟萃分析，评估了 IAT 对 90 天功能结局和 24 小时内症状性颅内出血（SICH）的影响。
三项试验符合荟萃分析的标准。IAT 治疗的患者更有可能具有改良 Rankin 量表（mRS）≤1（31%比 20%，OR 2.0，95%CI 1.2 至 3.4，p=0.01）；mRS≤2（43%比 31%，OR 1.9，95%CI 1.2 至 3.0，p=0.01）；和 NIH 中风量表评分 0 或 1（23%比 12%，OR 2.4，95%CI 1.3 至 4.4，p=0.007）在 90 天随访时。90 天时死亡率无影响（20%比 19%，OR 0.84，95%CI 0.5 至 1.5）。在积极治疗组中，SICH 的风险显著增加（11%比 2%，OR 4.6，95%CI 1.3 至 16，p=0.02）。
我们的荟萃分析表明，所有中风试验的标准功能终点在积极治疗组中均有显著改善。尽管 SICH 的风险增加，但死亡率没有影响。这些结果支持用动脉内溶栓剂对 MCA 闭塞引起的急性缺血性中风进行血管内治疗。
