Bai Xuesong, Zhang Xiao, Zhang Yanhong, Yang Wuyang, Wang Tao, Feng Yao, Wang Yan, Yang Kun, Wang Xue, Ma Yan, Jiao Liqun
China International Neuroscience Institute (China-INI), Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Transl Stroke Res. 2021 Jun;12(3):394-405. doi: 10.1007/s12975-021-00894-5. Epub 2021 Feb 2.
This systematic review and meta-analysis aimed to summarize the current literature on mechanical thrombectomy (MT) in nonagenarians and to provide updated clinical evidence of its feasibility, effectiveness, and safety in nonagenarians. PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant randomized controlled trials and observational studies that reported the clinical outcomes of nonagenarians with acute ischemic stroke after undergoing mechanical thrombectomy. Risk of bias was assessed using different scales. I statistic was used to evaluate the heterogeneity of the results, while meta-regression and sensitivity analyses were performed to investigate the source of heterogeneity. Thirteen studies and 657 patients were included. The estimated rate of successful revascularization was 80.82% (95% confidence interval [CI]: 77.48-83.97%), and the rate of favorable outcome (modified Rankin score [mRS] 0-2) was 21.60% (95% CI: 13.81-30.41%). The rate of good outcome (mRS score 0-3) was 23.08% (95% CI: 18.88-27.55%). The estimated risk of death during hospitalization was 20.55% (95% CI: 15.93-25.55%), while the mortality rate at 3 months was 44.38% (95% CI: 33.66-55.36%). The rate of intracranial hemorrhage (ICH) occurrence was 12.84% (95% CI: 5.27-22.68%), while the rate of symptomatic intracranial hemorrhage (sICH) was 3.52% (95% CI: 1.67-5.85%). The rate of hospital-related complications was 26.93% (95% CI: 10.53-47.03%). MT in nonagenarians demonstrated a high rate of successful revascularization. Conversely, the rate of futile revascularization is high with a low functional independence proportion. Therefore, MT should not be indiscriminately advocated in nonagenarians. Satisfactory results require careful selection of patients. Further high-quality studies are needed to clarify the selection algorithm.
本系统评价和荟萃分析旨在总结当前关于非agenarians机械取栓术（MT）的文献，并提供其在非agenarians中的可行性、有效性和安全性的最新临床证据。检索了PubMed、EMBASE、Cochrane图书馆和Web of Science，以查找报告非agenarians急性缺血性卒中接受机械取栓术后临床结局的相关随机对照试验和观察性研究。使用不同量表评估偏倚风险。采用I统计量评估结果的异质性，同时进行meta回归和敏感性分析以探究异质性来源。纳入了13项研究和657例患者。估计成功再血管化率为80.82%（95%置信区间[CI]：77.48 - 83.97%），良好结局（改良Rankin量表[mRS] 0 - 2）率为21.60%（95% CI：13.81 - 30.41%）。良好结局（mRS评分0 - 3）率为23.08%（95% CI：18.88 - 27.55%）。估计住院期间死亡风险为20.55%（95% CI：15.93 - 25.55%），而3个月时死亡率为44.38%（95% CI：33.66 - 55.36%）。颅内出血（ICH）发生率为12.84%（95% CI：5.27 - 22.68%），而症状性颅内出血（sICH）率为3.52%（95% CI：1.67 - 5.85%）。医院相关并发症率为26.93%（95% CI：10.53 - 47.03%）。非agenarians的MT显示出较高的成功再血管化率。相反，无效再血管化率高且功能独立比例低。因此，不应在非agenarians中不加区别地提倡MT。取得满意结果需要仔细选择患者。需要进一步的高质量研究来阐明选择算法。
