Li Wei, Lin Guo-Hui, Li Hong-Hong, Zhou Peng-Bo, Chen Yue-Yang, Sun Hong-Tao, Chen He-Cheng
The First School of Clinical Medical, Lanzhou University, Lanzhou, China.
Tianjin Key Laboratory of Neurotrauma Repair, Characteristic Medical Center of People's Armed Police Forces, Tianjin, China.
Front Neurol. 2024 Jun 4;15:1365876. doi: 10.3389/fneur.2024.1365876. eCollection 2024.
Whether the efficacy of combined stent retriever and contact aspiration (S + A) is superior to stent retriever (S) alone for revascularisation in patients with large vessel occlusive stroke remains uncertain. The aim of this meta-analysis was to assess the safety and efficacy of combined stent retriever and contact aspiration for the treatment of acute ischaemic stroke with large vessel occlusion by comparing it with stent retriever alone.
We systematically searched the PubMed, Embase, Web of Science, and The Cochrane Library databases for randomised controlled trials and observational studies (case-control and cohort studies) published before 1 October 2023 comparing the efficacy of combined stent retriever and contact aspiration versus tent retriever alone in patients with large vessel occlusive stroke. The end point of the primary efficacy observed in this meta-analysis study was the rate of first pass nearly complete or complete recanalisation (mTICI 2c-3). Secondary effectiveness nodes were: rate of first pass successful recanalisation (mTICI 2b-3), rate of near-complete or complete recanalisation of the postoperative vessel, rate of successful recanalisation of the postoperative vessel, and MRS 0-2 within 90 days. Safety endpoints were interoperative embolism, symptomatic intracranial haemorrhage, and mortality within 90 days.
A total of 16 studies were included in the literature for this meta-analysis, with a total of 7,320 patients (S + C group: 3,406, S group: 3,914). A comprehensive analysis of the included literature showed that combined stent retriever and contact aspiration had a higher rate of near-complete or complete recanalisation of the postoperative vessel [OR = 1.53, 95% CI (1.24, 1.88), < 0.0001] and rate of successful recanalisation of the postoperative vessel compared to stent retriever alone [OR = 1.83, 95% CI (1.55, 2.17), < 0.00001]; there were no statistically significant differences between the two groups in terms of the rate of first pass nearly complete or complete recanalisation [OR = 1.00, 95% CI (0.83, 1.19), = 0.96], rate of first pass successful recanalisation [OR = 1.02, 95% CI (0.85, 1.24), = 0.81], interoperative embolism [OR = 0.93, 95% CI (0.72, 1.20), = 0.56], symptomatic intracranial haemorrhage [OR = 1.14, 95% CI (0.87, 1.48), = 0.33], MRS 0-2 within 90 days [OR = 0.89, 95% CI (0.76, 1.04), = 0.14] and mortality within 90 days [OR = 1.11, 95% CI (0.94, 1.31), = 0.22].
Combined stent retriever and contact aspiration has a higher rate of postprocedural revascularisation (mTICI 2c-3/mTICI 2b-3) compared with stent retriever alone in patients with large vessel occlusion stroke. In addition, it was not superior to stenting alone in terms of the rate of first pass recanalisation (mTICI 2c-3/mTICI 2b-3), interoperative embolisation, symptomatic intracranial haemorrhage, good functional prognosis within 90 days and mortality within 90 days.
对于大血管闭塞性脑卒中患者，联合使用支架取栓器和接触抽吸术（S+A）在血管再通方面的疗效是否优于单纯使用支架取栓器（S）仍不确定。本荟萃分析的目的是通过将联合支架取栓器和接触抽吸术与单纯支架取栓器进行比较，评估其治疗大血管闭塞性急性缺血性脑卒中的安全性和疗效。
我们系统检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库，以查找2023年10月1日前发表的比较联合支架取栓器和接触抽吸术与单纯支架取栓器在大血管闭塞性脑卒中患者中的疗效的随机对照试验和观察性研究（病例对照研究和队列研究）。本荟萃分析研究中观察的主要疗效终点是首次通过时接近完全或完全再通率（mTICI 2c-3）。次要疗效指标包括：首次通过成功再通率（mTICI 2b-3）、术后血管接近完全或完全再通率、术后血管成功再通率以及90天内改良Rankin量表（MRS）评分为0-2分。安全性终点包括术中栓塞、症状性颅内出血和90天内死亡率。
本荟萃分析共纳入16项研究，总计7320例患者（S+C组：3406例，S组：3914例）。对纳入文献的综合分析表明，与单纯使用支架取栓器相比，联合支架取栓器和接触抽吸术术后血管接近完全或完全再通率更高[比值比（OR）=1.53，95%置信区间（CI）（1.24，1.88），P<0.0001]，术后血管成功再通率更高[OR=1.83，95%CI（1.55，2.17），P<0.00001]；两组在首次通过时接近完全或完全再通率[OR=1.00，95%CI（0.83，1.19），P=0.96]、首次通过成功再通率[OR=1.02，95%CI（0.85，1.24），P=0.81]、术中栓塞[OR=0.93，95%CI（0.72，1.20），P=0.56]、症状性颅内出血[OR=1.14，95%CI（0.87，1.48），P=0.33]、90天内MRS评分为0-2分[OR=0.89，95%CI（0.76，1.04），P=0.14]以及90天内死亡率[OR=1.11，95%CI（0.94，1.31），P=0.22]方面无统计学显著差异。
对于大血管闭塞性脑卒中患者，联合支架取栓器和接触抽吸术与单纯使用支架取栓器相比，术后血管再通率（mTICI 2c-3/mTICI 2b-3）更高。此外，在首次通过再通率（mTICI 2c-3/mTICI 2b-3）、术中栓塞、症状性颅内出血、90天内良好功能预后以及90天内死亡率方面，联合治疗并不优于单纯支架取栓术。
