Li Siying Shari, Trajkovski Aleksandar, Siarkowski Michael, Santiago Calvin, Eng Kevin A, Kishibe Teruko, Umakanthan Athithyan, Lang Eddy
Emergency Medicine, University of British Columbia, Vancouver, CAN.
Family Medicine, Dalhousie University, Halifax, CAN.
Cureus. 2020 May 18;12(5):e8187. doi: 10.7759/cureus.8187.
Objectives It remains uncertain whether computed tomography angiography (CTA) in ischemic strokes and transient ischemic attacks (TIAs) benefits patient outcomes beyond those eligible for endovascular therapy. We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) investigating the use of CTA against other imaging modalities for recurrent stroke, mortality, disability, emergency department (ED) revisits, or changes in management in ischemic stroke and TIA. (PROSPERO: 349590) Methods MEDLINE, Embase, and CENTRAL were searched. We included studies evaluating CTA against non-CTA imaging modalities for outcomes of interest in ischemic stroke or TIA. Two reviewers extracted data and assessed study quality. Data were pooled by the generic inverse variance method. Heterogeneity was assessed using Cochran's Q statistic and quantified by I. Quality of the evidence was assessed by GRADE. Results We found 12 eligible cohort studies involving 17,481 patients, and no eligible RCTs. No changes were detected in recurrent stroke, mortality, or disability when CTA was compared against pooled imaging modalities, nor compared to non-contrast computed tomography (NCCT) alone. The evidence for each outcome was graded as low quality to very low quality. Conclusions CTA use was not associated with significant reductions in recurrent stroke, mortality, or disability in ischemic stroke and TIA patient compared with other imaging modalities. More high-quality studies are needed.
对于缺血性卒中和短暂性脑缺血发作（TIA）患者，计算机断层血管造影（CTA）除了对那些适合血管内治疗的患者有益外，对其他患者预后是否有益仍不确定。我们对观察性研究和随机对照试验（RCT）进行了系统评价和荟萃分析，这些研究调查了CTA与其他成像方式相比，在缺血性卒中和TIA患者复发性卒中、死亡率、残疾、急诊科（ED）复诊或治疗管理变化方面的应用情况。（国际前瞻性系统评价注册库：349590）方法：检索MEDLINE、Embase和CENTRAL数据库。我们纳入了评估CTA与非CTA成像方式在缺血性卒中和TIA感兴趣结局方面的研究。两名研究者提取数据并评估研究质量。采用通用逆方差法合并数据。使用Cochran's Q统计量评估异质性，并通过I2进行量化。证据质量采用GRADE进行评估。结果：我们发现了12项符合条件的队列研究，涉及17481例患者，未发现符合条件的RCT。将CTA与汇总的成像方式相比，以及与单独的非增强计算机断层扫描（NCCT）相比，复发性卒中、死亡率或残疾方面均未发现变化。每个结局的证据质量等级为低质量到极低质量。结论：与其他成像方式相比，CTA的使用在缺血性卒中和TIA患者中并未显著降低复发性卒中、死亡率或残疾率。需要更多高质量的研究。
