Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Cerebrovasc Dis. 2023;52(6):711-719. doi: 10.1159/000529265. Epub 2023 Mar 23.
The aim of this study was to evaluate the effect of mechanical thrombectomy (MT) on the incidence of poststroke cognitive impairment (PSCI) in anterior circulation stroke.
Literature research was performed on PubMed/OVID/Cochrane CENTRAL for studies published in 2015-2022. A review of the references of the included papers was performed for further eligible articles. Clinical characteristics, NIHSS, dementia tests, and outcomes were recorded. The exclusion criteria were nonhuman and non-English. Studies qualities were assessed with MINORS/RoB2 and GRADE. A meta-analysis was performed using the standardized mean difference (Cohen's d) to measure effect size.
Four studies were included in the systematic review after screening 749 articles. No significant differences were found for age and gender (years: 66.70 ± 11.14 vs. 67.59 ± 10.11, p = 0.37; male 53.8% vs. 56.4%, p = 0.57). MT patients had a more severe stroke than that of the control group (NIHSS: 14.70 ± 4.31 vs. 11.17 ± 4.12; p < 0.0001). The control group consisted of medical therapy-alone patients in all studies. I2 was 76.95%, and Q was 43.4%. MT patients have better performance in overall cognition (d = 0.33 [0.074-0.58]) and in several cognitive domains than in the control group (TMT-A, d = 0.37 [0.04-0.70]; TMT-B, d = 0.35 [0.12-0.58]; digit span test [backward], d = 0.61 [0.18-1.06]; colored progressive matrices, d = 0.48 [0.05-0.91]; Stroop test [word reading], d = 0.60 [0.17-1.03]; color naming, d = 0.51 [0.08-0.94]; Rey-Osterrieth Complex Figure [immediate recall], d = 0.79 [0.35-1.23]; Rey Auditory Verbal Learning Test [immediate recall], d = 0.79 [0.36-1.23]; delayed recall, d = 0.46 [0.035-0.89]; and MOCA, d = 0.46 [-0.04 to 0.96]). Medical therapy patients had a higher score in coping strategy than MT patients (COPE-28 acceptance, d = -1.00 [-1.53 to -0.48]).
The incidence of PSCI is lower in MT patients than in the control group.
本研究旨在评估机械血栓切除术（MT）对前循环卒中后认知障碍（PSCI）发生率的影响。
对 2015 年至 2022 年发表的文献在 PubMed/OVID/Cochrane CENTRAL 进行文献检索。对纳入文献的参考文献进行综述，以获取其他合格文章。记录临床特征、NIHSS、痴呆测试和结局。排除标准为非人类和非英语。使用 MINORS/RoB2 和 GRADE 评估研究质量。使用标准化均数差（Cohen's d）来衡量效应大小，对数据进行荟萃分析。
经过筛选 749 篇文章后，有 4 项研究纳入系统评价。两组在年龄和性别方面无显著差异（年龄：66.70±11.14 岁 vs. 67.59±10.11 岁，p=0.37；男性 53.8% vs. 56.4%，p=0.57）。MT 组的卒中严重程度较对照组更严重（NIHSS：14.70±4.31 分 vs. 11.17±4.12 分；p＜0.0001）。所有研究中对照组均为仅接受药物治疗的患者。I2 为 76.95%，Q 值为 43.4%。MT 组在整体认知（d=0.33[0.074-0.58]）和几个认知领域（TMT-A，d=0.37[0.04-0.70]；TMT-B，d=0.35[0.12-0.58]；数字跨度测试[倒背]，d=0.61[0.18-1.06]；彩色渐进矩阵，d=0.48[0.05-0.91]；Stroop 测试[单词阅读]，d=0.60[0.17-1.03]；颜色命名，d=0.51[0.08-0.94]；Rey-Osterrieth 复杂图形[即刻回忆]，d=0.79[0.35-1.23]；Rey 听觉词语学习测试[即刻回忆]，d=0.79[0.36-1.23]；延迟回忆，d=0.46[0.035-0.89]；和 MoCA，d=0.46[-0.04 至 0.96]）方面的表现优于对照组。药物治疗组在应对策略方面的评分高于 MT 组（COPE-28 接受度，d=-1.00[-1.53 至-0.48]）。
MT 组的 PSCI 发生率低于对照组。
