Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA.
World Neurosurg. 2019 Oct;130:341-350. doi: 10.1016/j.wneu.2019.06.211. Epub 2019 Jul 5.
In patients who have failed systemic anticoagulation therapy, various endovascular approaches may assist in emergent recanalization.
We searched the PubMed database from January 1999 to August 2018 for studies that reported endovascular treatment modalities and associated clinical outcomes including recanalization, functional independence, mortality, or intracranial complications. Random-effect models were used to pool estimates across studies using R software.
Overall, 393 patients with cerebral venous thrombosis from 21 studies were included in the study. Transvenous local chemolysis treatment results were as follows: good outcome rate. 0.88 (95% confidence interval [CI], 0.80-0.93), mortality, 0.08 (95% CI, 0.04-0.16), postprocedural hemorrhagic rate, 0.11 (95% CI, 0.06-0.19), and complete recanalization rate, 0.59 (95% CI, 0.48-0.70). Transvenous mechanical thrombectomy results were as follows: good outcome rate, 0.66 (95% CI, 0.41-0.84), mortality, 0.09 (95% CI, 0.03-0.26), postprocedural hemorrhagic rate, 0.03 (95% CI, 0-0.16), and complete recanalization rate, 0.60 (95% CI, 0.35-0.80). Combined approach treatment results were as follows: good outcome rate, 0.80 (95% CI, 0.70-0.87), mortality, 0.10 (0.04-0.22), postprocedural hemorrhagic rate, 0.17 (95% CI, 0.10-0.27), and complete recanalization rate, 0.75 (95% CI, 0.64-0.84). Mixed approach to treatment results were as follows: good outcome rate, 0.61 (95% CI, 0.51-0.70), mortality, 0.23 (95% CI, 0.16-0.32), postprocedural hemorrhagic rate, 0.46 (95% CI, 0.33-0.59), and complete recanalization rate, 0.48 (95% CI, 0.37-0.58).
The combination approach treatment tended to have better outcomes, although this meta-analysis did not achieve statistical significance in all outcome parameters. Future studies are needed to establish the best treatment options with tailoring to specific clinical or angiographic scenarios.
在全身抗凝治疗失败的患者中，各种血管内方法可能有助于紧急再通。
我们从 1999 年 1 月至 2018 年 8 月在 PubMed 数据库中搜索了报道血管内治疗方式和相关临床结局的研究，包括再通、功能独立性、死亡率或颅内并发症。使用 R 软件的随机效应模型对研究间的估计值进行汇总。
总体而言，来自 21 项研究的 393 例脑静脉血栓形成患者纳入了该研究。经静脉局部化学溶解治疗的结果如下：良好结局率为 0.88（95%置信区间[CI]，0.80-0.93），死亡率为 0.08（95%CI，0.04-0.16），术后出血率为 0.11（95%CI，0.06-0.19），完全再通率为 0.59（95%CI，0.48-0.70）。经静脉机械血栓切除术的结果如下：良好结局率为 0.66（95%CI，0.41-0.84），死亡率为 0.09（95%CI，0.03-0.26），术后出血率为 0.03（95%CI，0-0.16），完全再通率为 0.60（95%CI，0.35-0.80）。联合治疗的结果如下：良好结局率为 0.80（95%CI，0.70-0.87），死亡率为 0.10（0.04-0.22），术后出血率为 0.17（95%CI，0.10-0.27），完全再通率为 0.75（95%CI，0.64-0.84）。混合方法治疗的结果如下：良好结局率为 0.61（95%CI，0.51-0.70），死亡率为 0.23（95%CI，0.16-0.32），术后出血率为 0.46（95%CI，0.33-0.59），完全再通率为 0.48（95%CI，0.37-0.58）。
联合治疗方法的结局较好，尽管本荟萃分析在所有结局参数中均未达到统计学意义。需要进一步的研究来确定最佳的治疗方案，以适应特定的临床或血管造影情况。
