Sivan-Hoffmann Rotem, Gory Benjamin, Rabilloud Muriel, Gherasim Dorin N, Armoiry Xavier, Riva Roberto, Labeyrie Paul-Emile, Gonike-Sadeh Udi, Eldesouky Islam, Turjman Francis
Department of Interventional Neuroradiology, Hospices Civils de Lyon, Pierre Wertheimer Neurological Hospita, Lyn, France.
Department of Interventional Neuroradiology, Rambam Health Care Campus, Haifa, Israel.
Isr Med Assoc J. 2016 Sep;18(9):561-566.
Mechanical thrombectomy with stent retrievers is now the reference therapy for acute ischemic stroke (AIS) in the anterior circulation in association with thrombolysis. We conducted an extensive systematic review and meta-analysis to evaluate the clinical and angiographic outcomes of stent-retriever thrombectomy in patients with acute anterior circulation stroke. Available literature published to date on observational studies and three randomized trials (MR CLEAN, ESCAPE, and EXTEND-IA) involving the stent-retriever device were reviewed. Successful recanalization and favorable clinical outcome were defined by a TICI ≥ 2b and modified Rankin Scale score of ≤ 2 at 90 days following AIS, respectively. A total of 2067 patients harboring an anterior circulation stroke were treated with a stent retriever: 433 patients from 3 randomized trials involving the device and 1634 patients from observational studies. Mean NIH Stroke Scale score on admission was 16.6, and mean time from onset to recanalization was 300 minutes. Successful recanalization was achieved in 82% (95%CI 77-86, 31 studies). The 90 day favorable outcome was achieved in 47% (95%CI 42-5.2, 34 studies) with an overall mortality rate of 17% (95%CI 13-20, 31 studies). Symptomatic intracerebral hemorrhage was identified in 6% (95%CI 4-8, 32 studies). In patients with AIS caused by a proximal intracranial occlusion of the anterior circulation, stent-retriever thrombectomy is safe and restores brain reperfusion in four of five treated patients, allowing favorable clinical outcome in one of two AIS patients with large vessel occlusion.
使用支架取栓器进行机械取栓术现已成为前循环急性缺血性卒中（AIS）联合溶栓治疗的参考疗法。我们进行了一项广泛的系统评价和荟萃分析，以评估急性前循环卒中患者使用支架取栓器取栓术的临床和血管造影结果。回顾了迄今为止发表的关于观察性研究以及三项涉及支架取栓器装置的随机试验（MR CLEAN、ESCAPE和EXTEND-IA）的现有文献。成功再通和良好临床结局分别定义为AIS后90天时脑梗死溶栓分级（TICI）≥2b和改良Rankin量表评分≤2。共有2067例患有前循环卒中的患者接受了支架取栓器治疗：其中433例来自三项涉及该装置的随机试验，1634例来自观察性研究。入院时美国国立卫生研究院卒中量表（NIHSS）评分的平均值为16.6，从发病到再通的平均时间为300分钟。82%（95%CI 77-86，31项研究）实现了成功再通。47%（95%CI 42-52，34项研究）的患者在90天时获得了良好结局，总体死亡率为17%（95%CI 13-20，31项研究）。6%（95%CI 4-8，32项研究）的患者出现了症状性脑出血。在前循环近端颅内闭塞导致的AIS患者中，支架取栓器取栓术是安全的，五分之四接受治疗的患者恢复了脑再灌注，在两名患有大血管闭塞的AIS患者中，有一名获得了良好的临床结局。
