Yaeger Kurt A, Martini Michael L, Hardigan Trevor, Ladner Travis, Hao Qing, Singh I Paul, Mocco J
Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
Neurosurgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
J Neurointerv Surg. 2020 Jun;12(6):568-573. doi: 10.1136/neurintsurg-2019-015383. Epub 2019 Oct 29.
Thrombectomy for patients with emergent large vessel occlusion (ELVO) is currently recognized as the standard of care for appropriately selected patients. As proven in several randomized clinical trials and meta-analyses, treatment with thrombectomy lowers rates of poor functional outcomes after ELVO, compared with standard medical management. However, combined mortality rates of the most recent, high-quality clinical trials have not been collectively assessed.
The goal of this study was to assess the combined mortality rates of patients with ELVO following thrombectomy using data from the most recent, high-quality clinical trials.
Meta-analysis was performed in clinical trials comparing thrombectomy and medical management for patients with anterior circulation ELVO. Cumulative rates of mortality (mRS 6) as well as mortality or severe disability (mRS 5-6) were calculated.
Ten clinical trials fit the inclusion criteria, including PISTE, REVASCAT, DAWN, THRACE, SWIFT PRIME, ESCAPE, DEFUSE 3, THERAPY, EXTEND-IA, and MR CLEAN, with 2233 patients assessed for mortality alone and 2229 for mortality or severe disability. There was a significantly reduced risk of death with thrombectomy compared with standard medical care (14.9% vs 18.3%, P=0.03; RR 0.81, 95% CI 0.67 to 0.98), as well as a reduced risk of mortality or severe disability (mRS 5-6) in ELVO patients treated with thrombectomy (21.1% vs 30.5%, P<0.0001; RR 0.69, 95% CI 0.60 to 0.80).
Overall, these results suggest a lower risk of death, as well as death or severe disability, in patients with ELVO treated with thrombectomy compared with medical management alone.
对于急性大血管闭塞（ELVO）患者，血栓切除术目前被认为是适合特定患者的标准治疗方法。正如在多项随机临床试验和荟萃分析中所证实的，与标准药物治疗相比，血栓切除术可降低ELVO后功能预后不良的发生率。然而，尚未对最新的高质量临床试验的综合死亡率进行总体评估。
本研究的目的是使用最新的高质量临床试验数据评估ELVO患者接受血栓切除术后的综合死亡率。
对比较血栓切除术与药物治疗的前循环ELVO患者的临床试验进行荟萃分析。计算死亡率（改良Rankin量表6分）以及死亡或严重残疾（改良Rankin量表5 - 6分）的累积发生率。
10项临床试验符合纳入标准，包括PISTE、REVASCAT、DAWN、THRACE、SWIFT PRIME、ESCAPE、DEFUSE 3、THERAPY、EXTEND - IA和MR CLEAN，其中2233例患者仅评估死亡率，2229例评估死亡或严重残疾情况。与标准药物治疗相比，血栓切除术显著降低了死亡风险（14.9%对18.3%，P = 0.03；相对危险度0.81，95%置信区间0.67至0.98），并且接受血栓切除术的ELVO患者死亡或严重残疾（改良Rankin量表5 - 6分）的风险也降低了（21.1%对30.5%，P < 0.0001；相对危险度0.69，95%置信区间0.60至0.80）。
总体而言，这些结果表明，与单纯药物治疗相比，接受血栓切除术的ELVO患者死亡以及死亡或严重残疾的风险更低。
