Zheng Jingwei, Shi Ligen, Xu Weilin, Zhao Ningning, Liang Feng, Zhou Jingyi, Zhang Jianmin
Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Endocrinology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Oncotarget. 2017 Aug 11;8(42):72972-72984. doi: 10.18632/oncotarget.20183. eCollection 2017 Sep 22.
Stroke is the crucial cause of death annually. Inconsistent results from the randomized controlled trials (RCTs) aroused controversy on efficacy of endovascular treatment (EVT).
To evaluate the efficacy of EVT in stroke patients. We searched three databases including PubMed, Web of science and the Cochrane Library from Jan 2011 to Apr 2017. Eligible studies were RCTs comparing EVT versus standard medical therapy alone. The primary outcomes were favorable functional outcomes (modified Rankin Scale score, 0-2) at 3 months. Meta regression analysis and subgroup analysis were used to explore potential influence factors responsible for the effectiveness of EVT.
Eleven RCTs involving 3018 patients were included in our study. EVT showed better functional outcomes at 90 days (OR, 1.71; 95% CI, 1.28-2.28; < 0.001) and a higher recanalization rate at 24h (OR, 6.49; 95% CI, 4.79-8.79; < 0.001). In meta-regression and subgroup analysis, primary outcomes were significantly better among patients with atrial fibrillation (Adj R-squared 46.30%, = 0.054; OR, 2.40; 95% CI, 1.81-3.19; < 0.001), patients without hyperlipidemia (Adj R-squared 35.21%, = 0.159; OR, 2.34; 95% CI, 1.80-3.04; < 0.001) and when new generation thrombectomy device was used (Adj R-squared 72.21%, = 0.011; OR, 2.14; 95% CI, 1.75-2.61; < 0.001).
EVT showed superior clinical outcomes compared with standard medical therapy. The rate of using new generation thrombectomy device was the critical factor influencing therapeutic outcome. Hyperlipidemia and atrial fibrillation may also cause the potential effect.
中风是每年的关键死因。随机对照试验（RCT）结果不一致引发了关于血管内治疗（EVT）疗效的争议。
为评估EVT对中风患者的疗效。我们检索了三个数据库，包括PubMed、科学网和Cochrane图书馆，检索时间为2011年1月至2017年4月。符合条件的研究为比较EVT与单纯标准药物治疗的RCT。主要结局为3个月时良好的功能结局（改良Rankin量表评分，0 - 2）。采用Meta回归分析和亚组分析来探索影响EVT疗效的潜在影响因素。
我们的研究纳入了11项涉及3018例患者的RCT。EVT在90天时显示出更好的功能结局（OR，1.71；95%CI，1.28 - 2.28；P < 0.001），在24小时时再通率更高（OR，6.49；95%CI，4.79 - 8.79；P < 0.001）。在Meta回归和亚组分析中，房颤患者（调整R平方46.30%，P = 0.054；OR，2.40；95%CI，1.81 - 3.19；P < 0.001）、无高脂血症患者（调整R平方35.21%，P = 0.159；OR，2.34；95%CI，1.80 - 3.04；P < 0.001）以及使用新一代取栓装置时（调整R平方72.21%，P = 0.011；OR，2.14；95%CI，1.75 - 2.61；P < 0.001）的主要结局明显更好。
与标准药物治疗相比，EVT显示出更好的临床结局。新一代取栓装置的使用比例是影响治疗效果的关键因素。高脂血症和房颤也可能产生潜在影响。
