Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR China; Capital Medical University, Beijing, PR China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
J Stroke Cerebrovasc Dis. 2024 Jul;33(7):107721. doi: 10.1016/j.jstrokecerebrovasdis.2024.107721. Epub 2024 Apr 13.
Endovascular therapy (EVT) is recommended for patients with acute large-vessel occlusion (LVO) However, its efficacy and safety compared to medical management (MM) in patients with a National Institutes of Health Stroke Scale (NIHSS) score of ≤6 remains unclear. This meta-analysis compared EVT with medical MM in patients with large vessel occlusion mild stroke treated between 2015 and 2023, following the publication of the first randomized controlled trial.
Biomedical database searches (inception to March 21, 2023) retrieved articles reporting favorable functional outcome(modified Rankin Scale [mRS] 0-1) and functional independence (mRS 0-2), 90-day mortality and symptomatic intracranial hemorrhage (sICH). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) to maintain methodological rigor and transparency in our meta-analysis.
We conducted a meta-analysis of 22 studies (4,985 patients) to reveal no significant differences in favorable functional outcomes and independence across all groups. However, in patients treated between 2015 and 2023, EVT exhibited a higher risk of 90-day mortality (Odds Ratio [OR] = 1.84, 95% Confidence Interval [CI] [1.10, 3.07], p = 0.02) and sICH (OR = 3.36, 95% CI [1.96, 6.66], p < 0.01). EVT correlated with elevated sICH in the anterior circulation (OR=2.94, 95%CI [1.82, 4.74], p<0.01) regardless of the proximal (OR=2.20, 95%CI [1.04, 4.69], p=0.04) or distal (OR=3.44, 95%CI [1.43, 8.32], p<0.01) location of the occlusion. EVT correlated with elevated sICH rates in patients treated within 6 hours of symptom onset or those with NHISS≤5.
In patients treated between 2015 and 2023, EVT and MM did not differ in efficacy in acute LVO mild stroke; MM associated with better safety outcomes. Rigorous randomized controlled trials are warranted.
血管内治疗（EVT）被推荐用于急性大血管闭塞（LVO）患者。然而，EVT 与 NIH 卒中量表（NIHSS）评分≤6 的患者的药物治疗（MM）相比，其疗效和安全性仍不清楚。本荟萃分析比较了 2015 年至 2023 年期间发表的第一项随机对照试验后，接受 EVT 与 MM 治疗的大血管闭塞性轻度卒中患者的结局。
生物医学数据库检索（从创建到 2023 年 3 月 21 日）检索了报告有利功能结局（改良 Rankin 量表[mRS]0-1）和功能独立性（mRS 0-2）、90 天死亡率和症状性颅内出血（sICH）的文章。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，以保持我们荟萃分析方法学的严谨性和透明度。
我们对 22 项研究（4985 名患者）进行了荟萃分析，结果显示所有组之间的有利功能结局和独立性均无显著差异。然而，在 2015 年至 2023 年期间接受治疗的患者中，EVT 90 天死亡率的风险更高（优势比[OR] = 1.84，95%置信区间[CI] [1.10，3.07]，p = 0.02）和 sICH（OR = 3.36，95%CI [1.96，6.66]，p < 0.01）。EVT 与前循环中的 sICH 升高相关（OR=2.94，95%CI [1.82，4.74]，p<0.01），而与闭塞的近端（OR=2.20，95%CI [1.04，4.69]，p=0.04）或远端（OR=3.44，95%CI [1.43，8.32]，p<0.01）无关。EVT 与症状发作后 6 小时内接受治疗或 NIHSS≤5 的患者的 sICH 发生率升高相关。
在 2015 年至 2023 年期间接受治疗的患者中，EVT 和 MM 在急性 LVO 轻度卒中的疗效上没有差异；MM 与更好的安全性结局相关。需要进行严格的随机对照试验。
