急性缺血性卒中血管内血栓切除术使用或不使用球囊导引导管的临床和操作结果：一项系统评价和荟萃分析以及一线技术亚组分析
Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis.
作者信息
Podlasek A, Dhillon P S, Jewett G, Shahein A, Goyal M, Almekhlafi M
机构信息
From the Department of Neuroscience and Vascular Simulation (A.P.), School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK
National Institute of Health Research Nottingham Biomedical Research Centre (A.P., P.S.D.), University of Nottingham, Nottingham, UK.
出版信息
AJNR Am J Neuroradiol. 2021 Aug;42(8):1464-1471. doi: 10.3174/ajnr.A7164. Epub 2021 May 27.
BACKGROUND
Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy.
PURPOSE
Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used.
DATA SOURCES
We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews.
STUDY SELECTION
We chose studies that compared using balloon guide catheters with not using them.
DATA ANALYSIS
Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes.
DATA SYNTHESIS
Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34-2.76; < .001), successful reperfusion (OR = 1.85; 95% CI, 1.42-2.40; < .001), and good functional outcome (OR =1.48; 95% CI, 1.27-1.73; < .001). Balloon guide catheters reduce the number of passes (mean difference = -0.35; 95% CI, -0.65 to -0.04; = .02), procedural time (mean difference = -19.73; 95% CI, -34.63 to -4.83; = .009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26-0.98; = .04), and mortality (OR = 0.72; 95% CI, 0.62-0.85; < .001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach.
LIMITATIONS
The analysis was based on nonrandomized trials with a moderate risk of bias.
CONCLUSIONS
Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.
背景
球囊导引导管越来越多地用于在血管内血栓切除术期间通过暂时阻断近端血流来改善血栓清除效果。
目的
我们的目的是总结文献，比较根据所使用的一线技术，使用或不使用球囊导引导管进行血管内血栓切除术的手术和临床结果。
数据来源
我们使用了PubMed/MEDLINE、EMBASE和Cochrane系统评价数据库。
研究选择
我们选择了比较使用球囊导引导管与不使用球囊导引导管的研究。
数据分析
进行随机效应荟萃分析，以比较作为首次通过效应、成功再灌注、通过次数、手术持续时间、动脉穿刺至再灌注时间、远端栓子和临床结果来衡量的手术结果。
数据综合
总体而言，对16项研究（5507例患者，50.8%使用球囊导引导管治疗，49.2%未使用）的荟萃分析表明，使用球囊导引导管增加了实现首次通过效应（OR = 1.92；95%CI，1.34 - 2.76；P <.001）、成功再灌注（OR = 1.85；95%CI，1.42 - 2.40；P <.001）和良好功能结局（OR = 1.48；95%CI，1.27 - 1.73；P <.001）的几率。球囊导引导管减少了通过次数（平均差 = -0.35；95%CI，-0.65至-0.04；P =.02）、手术时间（平均差 = -19.73；95%CI，-34.63至-4.83；P =.009）、远端或新区域栓子的发生率（OR = 0.5；95%CI，0.26 - 0.98；P =.04）和死亡率（OR = 0.72；95%CI，0.62 - 0.85；P <.001）。当一线技术为支架取栓器或接触抽吸时，观察到球囊导引导管有类似益处，但联合方法则不然。
局限性
该分析基于偏倚风险中等的非随机试验。
结论
当前文献表明，在血管内血栓切除术期间使用球囊导引导管可改善临床和手术结果，尤其是在使用一线支架取栓器时。
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