Longoni Marco, Giacomozzi Sebastiano, Pantoni Leonardo, Vidale Simone
Department of Neurology and Stroke Unit, Bufalini Hospital, AUSLRomagna, Cesena, Italy.
Department of Biomedical and Clinical Sciences, Neuroscience Research Center, University of Milan, Milan, Italy.
Neurol Sci. 2025 Feb;46(2):801-806. doi: 10.1007/s10072-024-07781-5. Epub 2024 Sep 30.
Endovascular treatment (EVT) is recommended for acute ischemic stroke due to large-vessel occlusion (LVO) and an ASPECTs ≥ 6. Recent randomized controlled trials (RCTs) have become available on effect of EVT in patients with LVO-related large core infarct stroke (ASPECTS 0-5). We conducted a systematic review and meta-analysis of trials on patients with large core infarct treated with thrombectomy compared to best medical therapy (BMT).
The study followed PRISMA guidelines. Primary endpoint was functional independence at 90 days (modified Rankin Scale mRS < 3). Secondary endpoints were 3-month moderate disability (mRS < 4), excellent outcome (mRS < 2) and change in mRS (shift analysis). Safety outcomes were: symptomatic intracranial hemorrhage (sICH) and 3-month mortality.
Seven RCTs were included with a total of 1964 patients. Functional independence was significantly more frequent in EVT vs BMT group (19.4% vs 8%; OR = 2.72, 95%CI = 2.06-3.61, p = 0.08; I2: 47%). Moderate outcome was also more prevalent in EVT group (OR = 2.00; 95%CI = 1.61 - 2.48, p = 0.17; I2: 46%) as well as excellent outcome (OR: 1.54, 95%CI = 1.07 - 2.22, p = 0.13; I2: 40%). Shift analysis was also significant with OR 1.59 (CI = 1.33-1.82 and p < 0.001). Finally sICH, that occurred in 68 patients, was more frequent in EVT (OR = 1.63, 95%CI = 0.99 - 2.69, p = 0.68; I2: 0%) while 3 m mortality was reduced in EVT (31% vs 37,1%, OR 0.76 CI = 0.62-0.92).
This updated pooled data show that, in LVO-stroke patients with a large core infarct, EVT plus BMT (as compared to BMT alone) increases significantly the chances of achieving a good functional outcome at 90 days and reduces the 3- month mortality despite a marginal increase in acute sICH.
对于因大血管闭塞（LVO）且ASPECTs≥6所致的急性缺血性卒中，推荐进行血管内治疗（EVT）。近期已有关于EVT治疗LVO相关大梗死核心卒中（ASPECTS 0 - 5）患者疗效的随机对照试验（RCT）。我们对血栓切除术治疗大梗死核心患者与最佳药物治疗（BMT）的试验进行了系统评价和荟萃分析。
本研究遵循PRISMA指南。主要终点为90天时的功能独立性（改良Rankin量表mRS＜3）。次要终点为3个月时中度残疾（mRS＜4）、良好结局（mRS＜2）以及mRS的变化（移位分析）。安全性结局为：症状性颅内出血（sICH）和3个月死亡率。
纳入7项RCT，共1964例患者。与BMT组相比，EVT组功能独立性更常见（19.4%对8%；OR = 2.72，95%CI = 2.06 - 3.61，p = 0.08；I²：47%）。EVT组中度结局也更普遍（OR = 2.00；95%CI = 1.61 - 2.48，p = 0.17；I²：46%）以及良好结局（OR：1.54，95%CI = 1.07 - 2.22，p = 0.13；I²：40%）。移位分析也有显著差异，OR为1.59（CI = 1.33 - 1.82且p＜0.001）。最后，68例患者发生sICH，EVT组更常见（OR = 1.63，95%CI = 0.99 - 2.69，p = 0.68；I²：0%），而EVT组3个月死亡率降低（31%对37.1%，OR 0.76，CI = 0.62 - 0.92）。
这些更新的汇总数据表明，在大梗死核心的LVO卒中患者中，EVT联合BMT（与单纯BMT相比）显著增加了90天时获得良好功能结局的机会，并降低了3个月死亡率，尽管急性sICH略有增加。
