串联性闭塞急诊颈动脉支架置入术的抗血小板方案特征：系统评价和荟萃分析。
Profile of antiplatelet regimens for emergent carotid stenting in tandem occlusion. Systematic review and meta-analysis.
机构信息
Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy.
Department of Neuroscience, UOC Neurology, S Camillo Forlanini Hospital, Rome, Italy.
出版信息
Clin Neurol Neurosurg. 2024 Dec;247:108595. doi: 10.1016/j.clineuro.2024.108595. Epub 2024 Oct 19.
AIM
To investigate the optimum antiplatelet therapy regimen (APTR) for emergent carotid artery stenting following mechanical thrombectomy (MT) in stroke patients with tandem occlusion.
METHODS
A literature search was performed on Pubmed/OVID/Cochran's CENTRAL database for studies from 2015 to 2022. Patient characteristics, antiplatelet regimen type, mTICI, 90 days-mRS, acute in-stent thrombosis (AIST), mortality, intracranial hemorrhage (ICH), and sample size were recorded. Exclusion criteria were non-English literature, sample size < 5 patients, other anticoagulant/antiplatelet therapy, and 100 % stent insertion in one study arm. The studies were assessed using MINORS/GRADE. Meta-analysis and meta-regression with a random effects model were performed. The outcomes were: 90 days-mRS, death, AIST and ICH RESULTS: Five-hundred-twenty-four studies were retrieved. After applying the exclusion criteria, the final population included 19/534 studies (3.6 %) for 880 patients (46.3 per article). I^2 and Q's Cochrane were 86.4 % and 132.5 for mRS, 19.9 % and 17.5 for death, 0 % and 9.4 for acute in-stent thrombosis and 62.1 % and 39.7 for intra-cranial haemorrhages, respectively. Patients in the aspirin subgroup had a significantly lower rate of functional independence (mRS≤2) than those in the DAPT subgroup (47 % [CI95 % 42.0 %-52.0 %] vs. 61.9 % [CI95 % 50.8-72.9]; p=0.0007;OR 0.75[CI95 % 0.56-1.01], p=0.06). DAPT significantly decreased the death rate compared with aspirin (8.6 % [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012). Anti-GPIIb/IIIa demonstrated a trend of increasing the probability of mortality versus DAPT (OR 1.88[CI95 % 0.93-3.86], p=0.08. No significant differences were observed between AIST and ICH in the treatment groups.
CONCLUSION
DAPT may increases the chance of obtaining an mRS score ≤2 and reduces mortality.
目的
探讨血栓切除术（MT）后紧急颈动脉支架置入术（CAS）中串联闭塞的卒中患者的最佳抗血小板治疗方案（APTR）。
方法
在 Pubmed/OVID/Cochran 的 CENTRAL 数据库中对 2015 年至 2022 年的文献进行了检索。记录患者特征、抗血小板方案类型、mTICI、90 天 mRS、急性支架内血栓形成（AIST）、死亡率、颅内出血（ICH）和样本量。排除标准为非英文文献、样本量<5 例、其他抗凝/抗血小板治疗、以及在一个研究臂中 100%支架置入。采用 MINORS/GRADE 对研究进行评估。采用随机效应模型进行荟萃分析和荟萃回归。结果：共检索到 524 项研究。应用排除标准后，最终纳入 19/534 项研究（3.6%），共 880 例患者（每项研究 46.3 例）。mRS 的 I^2 和 Q 的 Cochrane 分别为 86.4%和 132.5%，死亡的 I^2 和 Q 的 Cochrane 分别为 19.9%和 17.5%，急性支架内血栓形成的 I^2 和 Q 的 Cochrane 分别为 0%和 9.4%，颅内出血的 I^2 和 Q 的 Cochrane 分别为 62.1%和 39.7%。阿司匹林亚组的功能独立性（mRS≤2）率明显低于 DAPT 亚组（47%[95%CI95%42.0%-52.0%] vs. 61.9%[95%CI95%50.8%-72.9%]；p=0.0007；OR 0.75[95%CI95%0.56-1.01]，p=0.06）。与阿司匹林相比，DAPT 显著降低死亡率（8.6%[95%CI95%5.3%-11.9%] vs. 16.7%[95%CI95%11.1%-22.2%]；p=0.0012）。与 DAPT 相比，抗 GPIIb/IIIa 增加了死亡率的可能性（OR 1.88[95%CI95%0.93-3.86]，p=0.08）。各组间 AIST 和 ICH 无显著差异。
结论
DAPT 可能增加获得 mRS 评分≤2 的机会，并降低死亡率。
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