Pôle IMER, hospices civils de Lyon, 3, quai des Célestins, 69002 Lyon, France.
Hospices civils de Lyon/UMR-CNRS 5510/MATEIS, 69002 Lyon, France.
Rev Neurol (Paris). 2018 May;174(5):319-326. doi: 10.1016/j.neurol.2017.09.009. Epub 2018 Apr 26.
Endovascular thrombectomy has become the reference therapy for patients with large vessel occlusion (LVO). However, no meta-analysis including the THRACE Trial has yet been reported. Thus, the present review assessed the outcomes of stent retriever thrombectomy added to medical care compared with medical care alone in LVO patients.
A systematic review was conducted of all randomized controlled trials (RCTs) examining stent retrievers added to medical care vs medical care alone in the MEDLINE, Embase and Web of Science databases. Meta-analyses of 90-day functional outcomes and mortality, and the occurrence of symptomatic intracranial hemorrhage (sICH), with thrombectomy plus medical care vs medical care alone were performed.
Six multicenter RCTs involving 1673 patients were included. Successful recanalization (modified thrombolysis in cerebral ischemia grades 2b-3) was seen in 71% of patients (95% CI: 62-79%) after thrombectomy. These patients also had significantly higher rates of 90-day functional independence (mRS scores 0-2) compared with those receiving medical care only (OR: 2.14, 95% CI: 1.72-2.67; P<0.00001), as well as excellent outcomes (mRS scores 0-1, OR: 2.05, 95% CI: 1.58-2.67; P<0.00001). Also, the rate of functional independence was higher (OR: 2.39, 95% CI: 1.88-3.04; P<0.00001) in the subgroup analysis without the THRACE Trial. The effect of endovascular therapy on 90-day mortality was inconclusive (OR: 0.82, 95% CI: 0.62-1.07; P=0.15), and there was no increased occurrence of sICH (OR: 1.11, 95% CI: 0.66-1.88; P=0.70).
Stent retriever thrombectomy added to medical care improved 90-day functional outcomes compared with medical care alone with no impact on mortality and risk of sICH in LVO patients.
血管内血栓切除术已成为治疗大血管闭塞（LVO）患者的首选疗法。然而，目前尚无包括 THRACE 试验在内的荟萃分析。因此，本综述评估了支架取栓术联合药物治疗与单纯药物治疗相比，在 LVO 患者中的疗效。
系统检索了 MEDLINE、Embase 和 Web of Science 数据库中所有关于支架取栓术联合药物治疗与单纯药物治疗比较的随机对照试验（RCT）。对支架取栓术联合药物治疗与单纯药物治疗后 90 天的功能结局和死亡率以及症状性颅内出血（sICH）的发生率进行了荟萃分析。
纳入了 6 项多中心 RCT，共涉及 1673 例患者。血栓切除术患者的再通率（改良脑梗死溶栓分级 2b-3）为 71%（95%CI：62%-79%）。与单纯药物治疗组相比，接受支架取栓术联合药物治疗的患者 90 天功能独立（mRS 评分 0-2）的比例显著更高（OR：2.14，95%CI：1.72-2.67；P<0.00001），且预后良好（mRS 评分 0-1，OR：2.05，95%CI：1.58-2.67；P<0.00001）。此外，无 THRACE 试验亚组分析中，功能独立的比例更高（OR：2.39，95%CI：1.88-3.04；P<0.00001）。血管内治疗对 90 天死亡率的影响尚无定论（OR：0.82，95%CI：0.62-1.07；P=0.15），且 sICH 发生率无增加（OR：1.11，95%CI：0.66-1.88；P=0.70）。
支架取栓术联合药物治疗较单纯药物治疗可改善 LVO 患者 90 天的功能结局，而对死亡率和 sICH 风险无影响。
