Teo Yao Neng, Sia Ching-Hui, Tan Benjamin Y Q, Mingxue Jing, Chan Bernard, Sharma Vijay Kumar, Makmur Andrew, Gopinathan Anil, Yang Cunli, Loh Stanley, Ng Sheldon, Ong Shao Jin, Teoh Hock-Luen, Rathakrishnan Rahul, Andersson Tommy, Arnberg Fabian, Gontu Vamsi Krishna, Lee Tsong-Hai, Maus Volker, Meyer Lukas, Bhogal Pervinder, Spooner Oliver, Li Tony Yw, Soh Rodney Yh, Yeo Leonard Ll
National University of Singapore, Singapore.
Department of Cardiology, National University Heart Centre, Singapore.
J Neurointerv Surg. 2023 Feb;15(2):127-132. doi: 10.1136/neurintsurg-2021-018406. Epub 2022 Jan 31.
The use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent retriever and BGC alone, but this may be due to a lack of power in these studies. We therefore performed a meta-analysis on this subject.
A systematic literature search was performed on PubMed, Scopus, Embase/Ovid, and the Cochrane Library from inception to October 20, 2021. Our primary outcomes were the rate of successful final reperfusion (Treatment in Cerebral Ischemia (TICI) 2c-3) and first pass effect (FPE, defined as TICI 2c-3 in a single pass). Secondary outcomes were 3 month functional independence (modified Rankin Scale score of 0-2), mortality, procedural complications, embolic complications, and symptomatic intracranial hemorrhage (SICH). A meta-analysis was performed using RevMan 5,4, and heterogeneity was assessed using the I test.
Of 1629 studies identified, five articles with 2091 patients were included. For the primary outcomes, FPE (44.9% vs 45.4%, OR 1.04 (95% CI 0.90 to 1.22), I=57%) or final successful reperfusion (64.5% vs 68.6%, OR 0.98 (95% CI 0.81% to 1.20%), I=85%) was similar between the combination technique and stent retriever only groups. However, the combination technique had significantly less rescue treatment (18.8% vs 26.9%; OR 0.70 (95% CI 0.54 to 0.91), I=0%). This did not translate into significant differences in secondary outcomes in functional outcomes, mortality, emboli, complications, or SICH.
There was no significant difference in successful reperfusion and FPE between the combined techniques and the stent retriever and BGC alone groups. Neither was there any difference in functional outcomes, complications, or mortality.
在急性缺血性卒中血栓切除术联合使用球囊导引导管（BGC）、抽吸导管和取栓支架，尚未证明比单独使用取栓支架和BGC效果更好，但这可能是由于这些研究的检验效能不足。因此，我们针对该主题进行了一项荟萃分析。
在PubMed、Scopus、Embase/Ovid和Cochrane图书馆进行了一项系统的文献检索，检索时间从数据库建立至2021年10月20日。我们的主要结局指标为最终成功再灌注率（脑缺血治疗（TICI）2c - 3级）和首次通过效应（FPE，定义为单次通过时达到TICI 2c - 3级）。次要结局指标为3个月时的功能独立性（改良Rankin量表评分为0 - 2分）、死亡率、手术并发症、栓塞并发症和症状性颅内出血（SICH）。使用RevMan 5.4进行荟萃分析，并使用I²检验评估异质性。
在检索到的1629项研究中，纳入了5篇文章，共2091例患者。对于主要结局指标，联合技术组与仅使用取栓支架组之间的FPE（44.9%对45.4%，OR 1.04（95%CI 0.90至1.22），I² = 57%）或最终成功再灌注率（64.5%对68.6%，OR 0.98（95%CI 0.81%至1.20%），I² = 85%）相似。然而，联合技术组的补救治疗显著更少（18.8%对26.9%；OR 0.70（95%CI 0.54至0.91），I² = 0%）。这在功能结局、死亡率、栓子、并发症或SICH等次要结局指标方面并未转化为显著差异。
联合技术组与仅使用取栓支架和BGC组在成功再灌注和FPE方面无显著差异。在功能结局、并发症或死亡率方面也没有差异。
