Ye Gengfan, Wen Xuebin, Wang Hongcai, Sun Chengfeng, Pan Zhihao, Chen Maosong, Wang Boding, Li Zhenqiang
Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
J Neurointerv Surg. 2022 May;14(5). doi: 10.1136/neurintsurg-2021-017497. Epub 2021 May 25.
Both stent retriever (SR) and contact aspiration (CA) are widely used as first-line strategies for acute posterior circulation strokes (PCS). However, it is still unclear how CA and SR compare as the first-line treatment of acute PCS. Several new studies have been published recently, so we aimed to perform an updated meta-analysis.
The meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Random-effects models were performed to pool the outcomes and the value of I was calculated to assess the heterogeneity.
Ten observational studies with 1189 patients were included, among whom 492 received first-line CA and 697 received first-line SR. The pooled results revealed that first-line CA could achieve a significantly higher proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3 (OR 1.90, 95% CI 1.33 to 2.71, I=0%), mTICI 3 (OR 1.95, 95% CI 1.15 to 3.31, I=59.6%), first-pass effect (OR 2.91, 95% CI 1.51 to 5.58, I=0%), lower incidence of new-territory embolic events (OR 0.20, 95% CI 0.05 to 0.83, I=0%), and shorter procedure time (mean difference -29.4 min, 95% CI -46.8 to -12.0 min, I=62.8%) compared with first-line SR. At 90-day follow-up, patients subjected to first-line CA showed a higher functional independence (modified Rankin Scale score 0-2; OR 1.38, 95% CI 1.01 to 1.87, I=23.5%) and a lower mortality (OR 0.71, 95% CI 0.50 to 1.00, p=0.050, I=0%) than those subjected to first-line SR.
This meta-analysis suggests that the first-line CA strategy could achieve better recanalization and clinical outcomes for acute PCS than first-line SR. Limited by the quality of included studies, this conclusion should be drawn with caution.
支架取栓器（SR）和接触抽吸术（CA）均被广泛用作急性后循环卒中（PCS）的一线治疗策略。然而，CA和SR作为急性PCS的一线治疗方法相比效果如何仍不清楚。最近发表了几项新研究，因此我们旨在进行一项更新的荟萃分析。
根据PRISMA（系统评价和荟萃分析的首选报告项目）声明进行荟萃分析。采用随机效应模型汇总结果，并计算I值以评估异质性。
纳入了10项观察性研究，共1189例患者，其中492例接受一线CA治疗，697例接受一线SR治疗。汇总结果显示，与一线SR相比，一线CA能显著提高改良脑梗死溶栓（mTICI）2b/3级（比值比[OR]1.90，95%置信区间[CI]1.33至2.71，I=0%）、mTICI 3级（OR 1.95，95%CI 1.15至3.31，I=59.6%）的比例，首次通过效应（OR 2.91，95%CI 1.51至5.58，I=0%），降低新区域栓塞事件的发生率（OR 0.20，95%CI 0.05至0.83，I=0%），并缩短手术时间（平均差值-29.4分钟，95%CI -46.8至-12.0分钟，I=62.8%）。在90天随访时，接受一线CA治疗的患者比接受一线SR治疗的患者具有更高的功能独立性（改良Rankin量表评分0-2；OR 1.38，95%CI 1.01至1.87，I=23.5%）和更低的死亡率（OR 0.71，95%CI 0.50至1.00，p=0.050，I=0%）。
这项荟萃分析表明，对于急性PCS，一线CA策略比一线SR能实现更好的血管再通和临床结局。受纳入研究质量的限制，该结论应谨慎得出。
