Sheng Kevin, Tong Marcus
Department of Surgery, University of Sydney, Camperdown, NSW, Australia.
Department of Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Asian J Neurosurg. 2020 Apr 7;15(2):251-261. doi: 10.4103/ajns.AJNS_151_19. eCollection 2020 Apr-Jun.
This study aims to analyze the efficacy of aspiration thrombectomy for large vessel occlusion of the posterior circulation, with an emphasis on comparison with stent retriever thrombectomy.
A systematic review and meta-analysis were performed to analyze the outcomes of aspiration thrombectomy for acute posterior circulation stroke. For those studies that included data for both aspiration and stent-retriever thrombectomy, we additionally performed a second meta-analysis comparing their outcomes against each other.
A total of 17 articles were included. For the primary outcomes, the weighted pooled rate of mortality was 26.71% (95% confidence interval [CI] 19.35%-34.71%), modified Ranking Score (mRS) 0-2 at 3 months was 36.71 (95% CI 32.02%-41.52%), and successful recanalization 89.26% (95% CI 83.12%-94.31%). Primary stent retriever thrombectomy was inferior to primary aspiration thrombectomy for the outcomes of successful recanalization (odds ratio [OR] 0.57, 95% CI 0.36-0.91, = 0.018), complete recanalization (OR 0.65, 95% CI 0.42-0.1.00, = 0.048), procedure time (mean difference 28.17, 95% CI 9.47-46.87), and rate of embolization to new territory (OR 5.01, 95% CI 1.20-20.87, = 0.027). No significant difference was seen for other outcomes. Further subgroup analysis suggests that for the outcome of recanalization, this may be dependent on the availability of second-line stent retriever thrombectomy.
The included studies were observational in nature. There was unresolved heterogeneity in some of the outcomes.
There was no statistically significant difference seen for the primary outcomes of mortality and favorable outcome (mRS score 0-2) at 3 months. While superior rates of successful recanalization, complete recanalization, faster procedural time, and improved safety profile for primary aspiration thrombectomy were seen compared to primary stent retriever thrombectomy, this did not translate into superior clinical outcomes.
本研究旨在分析抽吸血栓切除术治疗后循环大血管闭塞的疗效，重点是与支架取栓术进行比较。
进行系统评价和荟萃分析，以分析急性后循环卒中抽吸血栓切除术的结果。对于那些同时包含抽吸和支架取栓术数据的研究，我们另外进行了第二项荟萃分析，比较两者的结果。
共纳入17篇文章。对于主要结局，加权合并死亡率为26.71%（95%置信区间[CI]19.35%-34.71%），3个月时改良Rankin量表（mRS）评分为0-2的比例为36.71（95%CI 32.02%-41.52%），成功再通率为89.26%（95%CI 83.12%-94.31%）。在成功再通（优势比[OR]0.57，95%CI 0.36-0.91，P = 0.018）、完全再通（OR 0.65，95%CI 0.42-1.00，P = 0.048）、手术时间（平均差值28.17，95%CI 9.47-46.87）和新区域栓塞率（OR 5.01，95%CI 1.20-20.87，P = 0.027）方面，初次支架取栓术劣于初次抽吸血栓切除术。其他结局未见显著差异。进一步的亚组分析表明，对于再通结局，这可能取决于二线支架取栓术的可用性。
纳入的研究本质上是观察性的。一些结局存在未解决的异质性。
3个月时死亡率和良好结局（mRS评分0-2）的主要结局未见统计学显著差异。虽然与初次支架取栓术相比，初次抽吸血栓切除术的成功再通率、完全再通率更高，手术时间更快，安全性更好，但这并未转化为更好的临床结局。
