Guo Yu, Wu Hao, Zhang Tian-Yi, Li Yu-Ping, Yang Jin-Cai, Yang Ming-Fei, Hu Yi-Qiao, Zhang Heng-Zhu
Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, 225009, Jiangsu, China.
Graduate School, Dalian Medical University, Dalian, 116044, Liaoning, China.
J Neurol. 2023 Jun;270(6):2924-2937. doi: 10.1007/s00415-023-11653-x. Epub 2023 Mar 2.
The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for patients with M2 occlusion. This study aims to compare the efficacy and safety of endovascular treatment (EVT) with best medical management (BMM) in patients with M2 occlusion, and to investigate whether the optimal treatment varies according to stroke severity.
Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT and BMM. According to stroke severity, the study population were classified into those with moderate-severe stroke and those with mild stroke. National Institute of Health Stroke Scale (NIHSS) scores ≥ 6 was defined as moderate-severe stroke, and NIHSS scores 0-5 as mild stroke. Random-effects meta-analyses were performed to measure the symptomatic intracranial hemorrhage (sICH) within 72 h, and the modified Rankin Scale (mRS) scores 0-2 and the mortality at 90 days.
Totally, 20 studies were identified, including 4358 patients. In the moderate-severe stroke population, the EVT had 82% higher odds for mRS scores 0-2 (OR 1.82, 95% CI 1.34-2.49) and a 43% lower odds for mortality (OR 0.57, 95% CI 0.39-0.82) compared with the BMM. However, no difference was found in the sICH rate (OR 0.88, 95% CI 0.44-1.77). In the mild stroke population, no differences were observed in the mRS scores 0-2 (OR 0.81, 95% CI 0.59-1.10) or mortality (OR 1.23, 95% CI 0.72-2.10) between EVT and BMM, whereas EVT was associated with higher sICH rate (OR 4.21, 95% CI 1.86-9.49).
EVT may be only beneficial for patients with M2 occlusion and high stroke severity, but not for those with NIHSS scores 0-5.
缺乏随机对照证据使得难以对M2段闭塞患者制定可靠的治疗建议。本研究旨在比较血管内治疗（EVT）与最佳药物治疗（BMM）对M2段闭塞患者的疗效和安全性，并探讨最佳治疗方案是否因卒中严重程度而异。
进行全面的文献检索，以确定直接比较EVT和BMM疗效的研究。根据卒中严重程度，将研究人群分为中重度卒中和轻度卒中患者。美国国立卫生研究院卒中量表（NIHSS）评分≥6定义为中重度卒中，NIHSS评分0-5为轻度卒中。采用随机效应荟萃分析来衡量72小时内的症状性颅内出血（sICH）、改良Rankin量表（mRS）评分0-2以及90天时的死亡率。
共纳入20项研究，包括4358例患者。在中重度卒中人群中，与BMM相比，EVT的mRS评分0-2的优势比高82%（OR 1.82，95%CI 1.34-2.49），死亡率的优势比低43%（OR 0.57，95%CI 0.39-0.82）。然而，sICH发生率无差异（OR 0.88，95%CI 0.44-1.77）。在轻度卒中人群中，EVT与BMM在mRS评分0-2（OR 0.81，95%CI 0.59-1.10）或死亡率（OR 1.23，95%CI 0.72-2.10）方面无差异，而EVT与较高的sICH发生率相关（OR 4.21，95%CI 1.86-9.）。
EVT可能仅对M2段闭塞且卒中严重程度高的患者有益，而对NIHSS评分0-5的患者无益。
