球囊导引导管与标准导引导管在急性缺血性脑卒中治疗中的比较：系统评价和荟萃分析。
Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
机构信息
Nested Knowledge, Inc., St. Paul, Minnesota, USA; Superior Medical Experts, St. Paul, Minnesota, USA.
Superior Medical Experts, St. Paul, Minnesota, USA.
出版信息
World Neurosurg. 2021 Oct;154:144-153.e21. doi: 10.1016/j.wneu.2021.07.034. Epub 2021 Jul 16.
BACKGROUND
Balloon guide catheters (BGCs) are designed to induce flow arrest during mechanical thrombectomy procedures for acute ischemic stroke due to large-vessel occlusion and have been associated with improved clinical and angiographic outcomes. We conducted a systematic review and meta-analysis evaluating the relative technical and clinical outcomes associated with BGC versus non-BGC approaches.
METHODS
A systematic review of clinical literature using the PubMed database was undertaken to identify multiarm studies published between 2010 and 2021 reporting the use of BGC versus non-BGC approaches for stroke treatment. Data collected included complete recanalization (thrombolysis in cerebral infarction, TICI), first-pass effect TICI 3, puncture-to recanalization time, number of endovascular attempts, distal embolization, symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score 0-2, and 90-day mortality. Subgroup analyses assessed the impact of treatment device (stent-retrievers, contact aspiration, combination therapy, and not specified/other). A random effects model was fit for each outcome measure.
RESULTS
Fifteen studies were included. Compared with non-BGC approaches, patients treated with BGCs had greater odds of TICI 3 (odds ratio [OR] 1.57; 95% confidence interval [95% CI] 1.08-2.29) and first-pass effect TICI 3 (OR 3.63; 95% CI 2.34-5.62), reduced puncture-to-revascularization time (mean difference -7.8; 95% CI -13.3 to -2.2), fewer endovascular attempts (mean difference -0.47; 95% CI -0.68 to -0.26), reduced odds of distal emboli (OR 0.34; 95% CI 0.17-0.71) and symptomatic intracerebral hemorrhage (OR 0.66; 95% CI 0.51-0.86), greater odds of 90-day modified Rankin Scale score 0-2 (OR 1.51; 95% CI 1.27-1.79), and reduced odds of mortality (OR 0.69; 95% CI 0.57-0.82).
CONCLUSIONS
BGCs yield superior technical and clinical outcomes while reducing patient complications.
背景
球囊引导导管（BGC）旨在通过机械血栓切除术治疗急性缺血性卒中时引起血流停止，与较大血管闭塞相关，并改善临床和血管造影结果。我们进行了一项系统评价和荟萃分析，评估 BGC 与非 BGC 方法相关的相对技术和临床结果。
方法
使用 PubMed 数据库进行系统的临床文献综述，以确定 2010 年至 2021 年期间发表的多臂研究，报告 BGC 与非 BGC 方法治疗卒中的使用情况。收集的数据包括完全再通（脑梗死溶栓，TICI）、初次通过效果 TICI 3、穿刺至再通时间、血管内尝试次数、远端栓塞、症状性颅内出血、90 天改良 Rankin 量表评分 0-2、90 天死亡率。亚组分析评估了治疗设备（支架回收器、接触抽吸、联合治疗和未指定/其他）的影响。为每个结果测量值拟合了随机效应模型。
结果
纳入了 15 项研究。与非 BGC 方法相比，接受 BGC 治疗的患者更有可能达到 TICI 3（优势比 [OR] 1.57；95%置信区间 [95%CI] 1.08-2.29）和初次通过效果 TICI 3（OR 3.63；95%CI 2.34-5.62），穿刺至再通时间缩短（平均差 -7.8；95%CI -13.3 至 -2.2），血管内尝试次数减少（平均差 -0.47；95%CI -0.68 至 -0.26），远端栓塞的可能性降低（OR 0.34；95%CI 0.17-0.71）和症状性颅内出血（OR 0.66；95%CI 0.51-0.86），90 天改良 Rankin 量表评分 0-2 的可能性更高（OR 1.51；95%CI 1.27-1.79），死亡率降低（OR 0.69；95%CI 0.57-0.82）。
结论
BGC 产生更好的技术和临床结果，同时减少患者并发症。
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