Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia.
Department of Vascular Surgery, 251 HAF and VA Hospital, Athens, Greece.
Neurosurgery. 2020 Apr 1;86(4):464-477. doi: 10.1093/neuros/nyz258.
Recent randomized control trials (RCTs) established that mechanical thrombectomy is superior to medical therapy for patients with stroke due to a large vessel occlusion.
To compare the safety and efficacy profile of the different mechanical thrombectomy strategies.
A random-effects meta-analysis was performed and the I2 statistic was used to assess heterogeneity according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Nineteen studies with a total of 2449 patients were included. No differences were identified between the stent retrieval and direct aspiration groups in terms of modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 and mTICI 3 recanalization rates, and favorable outcomes (modified Rankin Scale [mRS] ≤ 2). Adverse event rates, including 90-d mortality, symptomatic intracerebral hemorrhage (sICH), and subarachnoid hemorrhage (SAH), were similar between the stent retrieval and direct aspiration groups. The use of the stent retrieval was associated with a higher risk of vasospasm (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.10-8.09; I2: 0%) compared to direct aspiration. When compared with the direct aspiration group, the subgroup of patients who underwent thrombectomy with the combined approach as a first-line strategy had a higher likelihood of successful mTICI 2b/3 (OR: 1.47; 95% CI: 1.02-2.12; I2: 0%) and mTICI 3 recanalization (OR: 3.65; 95% CI: 1.56-8.54), although with a higher risk of SAH (OR: 4.33; 95% CI: 1.15-16.32).
Stent retrieval thrombectomy and direct aspiration did not show significant differences. Current available evidence is not sufficient to draw conclusions on the best surgical approach. The combined use of a stent retriever and aspiration as a first-line strategy was associated with higher mTICI 2b/3 and mTICI 3 recanalization rates, although with a higher risk of 24-h SAH, when compared with direct aspiration.
最近的随机对照试验（RCT）表明，对于大血管闭塞引起的中风患者，机械取栓术优于药物治疗。
比较不同机械取栓策略的安全性和疗效特征。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，采用随机效应荟萃分析，并用 I2 统计量评估异质性。
共纳入 19 项研究，共计 2449 例患者。支架取栓组与直接抽吸组在改良脑梗死溶栓（mTICI）2b/3 和 mTICI 3 再通率以及良好结局（改良 Rankin 量表[mRS]≤2）方面无差异。支架取栓组与直接抽吸组不良事件发生率，包括 90 天死亡率、症状性颅内出血（sICH）和蛛网膜下腔出血（SAH）相似。与直接抽吸相比，支架取栓的血管痉挛风险更高（比值比[OR]：2.98；95%置信区间[CI]：1.10-8.09；I2：0%）。与直接抽吸组相比，作为一线策略首先进行联合治疗的患者亚组mTICI 2b/3 （OR：1.47；95% CI：1.02-2.12；I2：0%）和 mTICI 3 再通（OR：3.65；95% CI：1.56-8.54）的成功率更高，但 SAH 风险更高（OR：4.33；95% CI：1.15-16.32）。
支架取栓和直接抽吸之间没有显著差异。目前的证据还不足以得出最佳手术方法的结论。与直接抽吸相比，支架取栓联合抽吸作为一线策略与更高的 mTICI 2b/3 和 mTICI 3 再通率相关，但 24 小时内 SAH 的风险更高。
