Department of Neurology, Guangxi Medical University First Affiliated Hospital, Nanning, China.
Department of Neurology, Guangxi Medical University Second Affiliated Hospital, Nanning, China.
J Neurointerv Surg. 2022 Apr;14(4):321-325. doi: 10.1136/neurintsurg-2021-017928. Epub 2021 Aug 4.
In this review and meta-analysis we sought to compare the efficacy and safety of direct endovascular thrombectomy (EVT) and bridging therapy for intravenous thrombolysis (IVT)-eligible patients with acute ischemic stroke caused by large vessel occlusions (AIS-LVO).
We searched Medline, Embase, and the Cochrane Library for published randomized clinical trials (RCTs) and observational studies providing outcomes of patients with IVT-eligible AIS-LVO who have undergone EVT with or without IVT. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes included the rates of (1) an excellent outcome defined as an mRS score of 0 or 1 at 90 days, (2) mortality at 90 days, (3) symptomatic intracranial hemorrhage (sICH), (4) any type of intracranial hemorrhage (ICH), (5) successful recanalization, and (6) clot migration.
We included three RCTs and six observational studies (4 of which were propensity score-adjusted studies) with a total of 3133 patients. In unadjusted and adjusted analyses, no differences in the rates of mRS scores 0-2, mRS scores 0-1, mortality at 90 days, sICH or successful recanalization were detected between patients with AIS-LVO who underwent direct EVT or bridging therapy. The patients treated with direct EVT had a lower risk ratio for any type of ICH and clot migration than did the patients treated with bridging therapy.
Compared with bridging therapy, direct EVT may be equally effective and yield a lower rate of ICH and clot migration in patients with AIS.
PROSPERO: CRD42021236691.
在本次综述和荟萃分析中，我们旨在比较直接血管内血栓切除术（EVT）和静脉溶栓桥接治疗对大血管闭塞性急性缺血性脑卒中（AIS-LVO）患者的疗效和安全性。
我们检索了 Medline、Embase 和 Cochrane 图书馆中已发表的随机临床试验（RCT）和观察性研究，这些研究提供了接受 EVT 联合或不联合 IVT 的 IVT 适应证 AIS-LVO 患者的结局。主要结局为 90 天时改良 Rankin 量表（mRS）评分 0-2 的患者比例。次要结局包括：（1）90 天时 mRS 评分 0 或 1 的患者比例（优效结局），（2）90 天时死亡率，（3）症状性颅内出血（sICH），（4）任何类型的颅内出血（ICH），（5）血管再通成功，（6）血栓迁移。
我们纳入了三项 RCT 和六项观察性研究（其中四项为倾向评分调整研究），共纳入 3133 例患者。在未调整和调整分析中，直接 EVT 组和桥接治疗组的 mRS 评分 0-2、mRS 评分 0-1、90 天死亡率、sICH 或血管再通成功率均无差异。直接 EVT 组患者发生任何类型 ICH 和血栓迁移的风险比低于桥接治疗组。
与桥接治疗相比，直接 EVT 可能对 AIS 患者同样有效，ICH 和血栓迁移的发生率更低。
PROSPERO：CRD42021236691。
