Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia; Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; Interventional Neuroradiology, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):108002. doi: 10.1016/j.jstrokecerebrovasdis.2024.108002. Epub 2024 Sep 7.
The efficacy and safety of endovascular thrombectomy (EVT) beyond 6 hours from stroke onset for patients with large vessel occlusion (LVO) selected without CT perfusion(CTP) or MR imaging(MRI) is undetermined. We conducted a systematic review and meta-analysis of the current literature comparing outcomes for late presenting patients with LVO treated by best medical management (BMM) with those selected for EVT based only on non-contrast CT(NCCT)/CT angiography(CTA) (without CTP or MRI).
PRISMA guidelines were employed. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months. Secondary outcomes were symptomatic intracranial haemorrhage (sICH) and mortality at 3 months. Data were analysed using the random-effects model.
Six studies of 2083 patients, including three randomised controlled trials, were included; 1271 patients were treated with EVT and 812 patients with BMM. Compared to BMM, patients treated with EVT demonstrated higher odds of achieving functional independence (39.0 % EVT vs 22.0 % BMM; OR = 2.55, 95 %CI 1.61-4.05,p < 0.0001, I = 74 %). The rates of sICH (OR = 2.09, 95 %CI 0.86-5.04,p = 0.10) and mortality (OR = 0.62, 95 %CI 0.35-1.10,p = 0.10) were not significantly different between each cohort.
Compared to BMM, late presenting stroke patients selected for EVT eligibility with NCCT/CTA only and treated with EVT achieved significantly higher rates of functional independence at 90 days, without increasing the incidence of sICH or mortality. Whilst these findings indicate that NCCT/CTA only may be used for EVT eligibility selection for patients who present beyond 6 hours from stroke onset, the results should be interpreted with caution due to the substantial heterogeneity between studies.
对于未经 CT 灌注（CTP）或 MRI 检查选择的大血管闭塞（LVO）患者，发病 6 小时后血管内血栓切除术（EVT）的疗效和安全性尚未确定。我们对当前文献进行了系统评价和荟萃分析，比较了仅根据非对比 CT（NCCT）/CT 血管造影（CTA）（无 CTP 或 MRI）选择接受最佳药物治疗（BMM）的 LVO 晚期患者与接受 EVT 治疗的患者的结局。
采用 PRISMA 指南。主要结局为 3 个月时的功能独立性（改良 Rankin 量表 0-2 分）。次要结局为 3 个月时的症状性颅内出血（sICH）和死亡率。使用随机效应模型进行数据分析。
纳入了 6 项共 2083 例患者的研究，包括 3 项随机对照试验，其中 1271 例患者接受 EVT 治疗，812 例患者接受 BMM 治疗。与 BMM 相比，接受 EVT 治疗的患者实现功能独立性的可能性更高（39.0%EVT 与 22.0%BMM；OR=2.55，95%CI 1.61-4.05，p<0.0001，I=74%）。sICH 发生率（OR=2.09，95%CI 0.86-5.04，p=0.10）和死亡率（OR=0.62，95%CI 0.35-1.10，p=0.10）在两组之间无显著差异。
与 BMM 相比，仅使用 NCCT/CTA 选择进行 EVT 治疗的 LVO 晚期患者在 90 天内实现功能独立性的比例显著提高，而 sICH 或死亡率并未增加。虽然这些发现表明，对于发病 6 小时后就诊的患者，仅使用 NCCT/CTA 即可用于 EVT 资格选择，但由于研究之间存在很大的异质性，结果应谨慎解释。
