Morsi Rami Z, Elfil Mohamed, Ghaith Hazem S, Aladawi Mohammad, Elmashad Ahmad, Kothari Sachin, Desai Harsh, Prabhakaran Shyam, Al-Mufti Fawaz, Kass-Hout Tareq
Department of Neurology, University of Chicago, Chicago, IL, USA.
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
J Stroke. 2023 May;25(2):214-222. doi: 10.5853/jos.2023.00752. Epub 2023 May 30.
New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only.
We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach.
Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low-certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD -0.7%, 95% CI -3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI -0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only.
Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.
新研究表明，血管内血栓切除术（EVT）对于具有大面积缺血区域的急性缺血性卒中（AIS）患者是安全有效的。我们研究的目的是对比较EVT与单纯药物治疗的随机试验进行实时系统评价和荟萃分析。
我们检索了MEDLINE、Embase和Cochrane图书馆，以确定比较EVT与单纯药物治疗在具有大面积缺血区域的AIS患者中的随机对照试验（RCT）。我们使用固定效应模型进行荟萃分析，以比较EVT与单纯标准药物治疗之间的功能独立性、死亡率和症状性颅内出血（sICH）。我们使用Cochrane偏倚风险工具评估偏倚风险，并使用推荐分级、评估、制定和评价方法评估每个结局的证据确定性。
在14513条引文中，我们纳入了3项RCT，共1010名参与者。我们发现，对于接受EVT的大面积梗死AIS患者，与单纯药物治疗相比，功能独立患者比例可能大幅增加（风险差[RD]30.3%，95%CI 15.0%至52.3%）的证据确定性较低，死亡率可能小幅非显著降低（RD -0.7%，95%CI -3.8%至3.5%）的证据确定性较低，sICH可能小幅非显著增加（RD 3.1%，95%CI -0.3%至9.8%）的证据确定性较低。
低确定性证据表明，与单纯药物治疗相比，接受EVT的大面积梗死AIS患者的功能独立性可能大幅增加，死亡率小幅非显著降低，sICH小幅非显著增加。
