Diestro Jose Danilo B, Dmytriw Adam A, Broocks Gabriel, Chen Karen, Hirsch Joshua A, Kemmling Andre, Phan Kevin, Bharatha Aditya
Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada.
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Can J Neurol Sci. 2020 Sep;47(5):612-619. doi: 10.1017/cjn.2020.71. Epub 2020 Apr 17.
The current American Heart Association guidelines for acute ischemic stroke reserve Grade 1A recommendation for the use of endovascular thrombectomy (EVT) for patients with an Alberta Stroke Program Early Computed Tomography Score (ASPECTS) of ≥6.
We aim to determine the safety and efficacy of EVT for large vessel occlusion ischemic stroke patients with low ASPECTS (5 or less).
Medline, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for studies appraising the outcomes of EVT for low ASPECTS ischemic stroke. A meta-analysis of proportions compared the clinical outcomes of patients undergoing EVT and those receiving best medical therapy only.
Nine studies (1,196 patients) were included. There was a trend (p = 0.11) toward a higher rate of symptomatic intracranial hemorrhage (sICH) in the EVT group (9.2%; 95% CI 6.1-13.6; I2 53.37%) compared to the medical group (5.5%; 95% CI 3.7-8.1; I2 0%). There was no difference (p = 0.41) in the pooled 90-day mortality of EVT patients (30.7%; 95% CI 21.7-41.5; I2 84.23%) and medical patients (36.6%; 95% CI 26.4-48.1; I2 76.2%). EVT patients had better (p = 0.001) 90-day outcomes, with 27.7% (95% CI 21.8-34.5; I2 62.08%) of patients attaining a modified Rankin Scale of 0-2 compared to only 3.7% (95% CI 2.3-5.9; I2 87.21%) in the medical group.
This meta-analysis demonstrates a trend in higher sICH among low ASPECTS patients undergoing EVT. Despite this, a significant proportion of this subset of patients still achieved good functional outcomes at 90 days. Randomized trials are necessary to substantiate this result as significant bias is inherent in the observational studies included in this review.
美国心脏协会当前关于急性缺血性卒中的指南将阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）≥6分的患者使用血管内血栓切除术（EVT）列为1A级推荐。
我们旨在确定EVT治疗ASPECTS评分低（5分或更低）的大血管闭塞性缺血性卒中患者的安全性和有效性。
检索Medline、Cochrane对照试验中央注册库和ClinicalTrials.gov，以查找评估EVT治疗低ASPECTS评分缺血性卒中结局的研究。比例的荟萃分析比较了接受EVT治疗的患者和仅接受最佳药物治疗的患者的临床结局。
纳入9项研究（1196例患者）。与药物治疗组（5.5%；95%CI 3.7-8.1；I² 0%）相比，EVT组有症状性颅内出血（sICH）发生率更高的趋势（p = 0.11）（9.2%；95%CI 6.1-13.6；I² 53.37%）。EVT组患者（30.7%；95%CI 21.7-41.5；I² 84.23%）和药物治疗组患者（36.6%；95%CI 26.4-48.1；I² 76.2%）的90天合并死亡率无差异（p = 0.41）。EVT组患者90天结局更好（p = 0.001），27.7%（95%CI 21.8-34.5；I² 62.08%）的患者改良Rankin量表评分为0-2分，而药物治疗组仅为3.7%（95%CI 2.3-5.9；I² 87.21%）。
这项荟萃分析表明，接受EVT治疗的低ASPECTS评分患者中sICH发生率有升高趋势。尽管如此，这部分患者中有很大比例在90天时仍取得了良好的功能结局。由于本综述纳入的观察性研究存在固有显著偏倚，因此需要进行随机试验来证实这一结果。
