Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neuroradiology. 2021 May;63(5):795-807. doi: 10.1007/s00234-020-02586-7. Epub 2020 Oct 21.
This systematic review and meta-analysis summarized the current literature to compare the safety and efficacy between first-pass effect (FPE) and multiple-pass effect (MPE) for thrombectomy in treatment of acute ischemic stroke (AIS).
Major databases were searched for studies which reported clinical outcomes regarding successful or complete recanalization after first pass of mechanical thrombectomy in AIS. The assessment of bias was performed using different scales. I statistic was used to evaluate heterogeneity between reviewers. Subgroup, meta-regression, and sensitivity analyses were conducted to explore the source of heterogeneity. Visualization of funnel plots was used to evaluate publication bias.
A total of 9 studies were eligible for final analysis. For successful recanalization (mTICI 2b-3), favorable outcomes were seen in 49.7% (95% confidence interval (CI): 40.5-58.9%) and 34.7% (95% CI: 26.8-42.7%) of FPE and MPE patients, respectively. Mortality at 3 months was 13.8% (95% CI: 10.8-16.9%) and 26.0% (95% CI: 17.7-34.2%), respectively. For complete recanalization (mTICI 2c-3), proportion of favorable outcomes were 62.7% (95% CI: 51.2-74.2%) and 47.7% (95% CI: 37.4-58.0%) in FPE and MPE; mortality was seen in 11.5% (95% CI: 4.9-18.2%) and 17.0% (95% CI: 5.2-28.7%), respectively. For AIS with successful recanalization, FPE had more favorable outcome (odds ratio (OR): 1.85, 95% CI: 1.48-2.30; p < 0.01; I = 0%) and lower mortality than MPE (OR: 0.58, 95% CI: 0.42-0.79; p = 0.001; I = 61.9%). Similar results were seen in a subgroup analysis of patients with complete recanalization, with FPE having better outcome (OR: 1.79, 95% CI: 1.40-2.28; p < 0.01; I = 0%) and lower mortality risk (OR: 0.61, 95% CI: 0.44-0.86; p = 0.005; I = 0%) compared to MPE.
FPE is associated with better outcomes than MPE after achieving successful or complete recanalization.
本系统评价和荟萃分析总结了目前的文献，比较了急性缺血性脑卒中（AIS）机械取栓术首次通过（FPE）和多次通过（MPE）的安全性和疗效。
检索了主要数据库中关于 AIS 机械取栓术首次通过后成功或完全再通的临床结局的研究。使用不同的量表评估偏倚。使用 I ² 统计量评估审稿人之间的异质性。进行亚组分析、荟萃回归分析和敏感性分析，以探讨异质性的来源。使用漏斗图可视化评估发表偏倚。
共有 9 项研究符合最终分析的条件。对于成功再通（mTICI 2b-3），FPE 组和 MPE 组的患者分别有 49.7%（95%置信区间[CI]：40.5-58.9%）和 34.7%（95% CI：26.8-42.7%）获得良好结局。3 个月死亡率分别为 13.8%（95% CI：10.8-16.9%）和 26.0%（95% CI：17.7-34.2%）。对于完全再通（mTICI 2c-3），FPE 组和 MPE 组的患者分别有 62.7%（95% CI：51.2-74.2%）和 47.7%（95% CI：37.4-58.0%）获得良好结局；死亡率分别为 11.5%（95% CI：4.9-18.2%）和 17.0%（95% CI：5.2-28.7%）。对于成功再通的 AIS 患者，FPE 比 MPE 具有更好的结局（比值比[OR]：1.85，95% CI：1.48-2.30；p<0.01；I=0%）和更低的死亡率（OR：0.58，95% CI：0.42-0.79；p=0.001；I=61.9%）。在完全再通患者的亚组分析中也得到了相似的结果，FPE 具有更好的结局（OR：1.79，95% CI：1.40-2.28；p<0.01；I=0%）和更低的死亡风险（OR：0.61，95% CI：0.44-0.86；p=0.005；I=0%）。
在实现成功或完全再通后，FPE 与 MPE 相比，结局更好。
