药物洗脱支架与裸金属支架治疗症状性颅内和椎动脉狭窄的疗效与安全性：一项荟萃分析。
Efficacy and safety of drug-eluting stents versus bare-metal stents in symptomatic intracranial and vertebral artery stenosis: a meta-analysis.
作者信息
Zhang Yidan, Li Wenbin, Zhang Lei
机构信息
Department of Emergency, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Department of Neurovascular Disease, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
出版信息
Front Neurol. 2024 Nov 5;15:1389254. doi: 10.3389/fneur.2024.1389254. eCollection 2024.
OBJECTIVES
This study aims to present the first comprehensive meta-analysis assessing the effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in treating intracranial and vertebral artery stenosis.
METHODS
A comprehensive examination was undertaken to compare the effectiveness and safety of DES and BMS in individuals experiencing symptomatic stenosis in the intracranial and vertebral arteries through an in-depth analysis of clinical research. We conducted an extensive search across multiple databases including PubMed, Embase, Web of Science, and the Cochrane Library up to September 2024. The emphasis of our investigation was on various outcomes including rates of in-stent restenosis, symptomatic occurrences of in-stent restenosis, incidence of stroke, procedural success, mortality rates, complications associated with the procedure, and any adverse events.
RESULTS
Our analysis included 12 studies with a total of 1,243 patients (562 in the DES group and 681 in the BMS group). The findings demonstrated a significantly lower rate of in-stent restenosis in the DES group for both intracranial [odds ratio (OR): 0.23; 95% confidence interval (CI): 0.13 to 0.41; < 0.00001] and vertebral artery stenosis (OR: 0.38; 95% CI: 0.20 to 0.72; = 0.003) compared to the BMS group. Additionally, the DES group showed a significantly reduced rate of postoperative strokes in vertebral artery stenosis cases (OR: 0.38; 95% CI: 0.16 to 0.90; = 0.03), with no significant differences noted in the intracranial artery stenosis comparison (OR: 0.63; 95% CI: 0.20 to 1.95; = 0.42). The study also revealed no significant disparities in symptomatic in-stent restenosis, procedural success, mortality, adverse effects, and perioperative complications between the two groups across the conditions studied.
CONCLUSION
The comparison indicates that DES significantly reduces the risk of in-stent restenosis and postoperative strokes in patients with vertebral artery stenosis, compared to BMS. For both intracranial and vertebral artery stenosis, DES and BMS exhibit comparable safety profiles.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967.
目的
本研究旨在首次进行全面的荟萃分析，评估药物洗脱支架（DES）与裸金属支架（BMS）治疗颅内和椎动脉狭窄的有效性和安全性。
方法
通过对临床研究的深入分析，全面比较DES和BMS在颅内和椎动脉有症状性狭窄患者中的有效性和安全性。我们在包括PubMed、Embase、Web of Science和Cochrane图书馆在内的多个数据库中进行了广泛检索，直至2024年9月。我们调查的重点是各种结果，包括支架内再狭窄率、支架内再狭窄的症状性发生、中风发生率、手术成功率、死亡率、与手术相关的并发症以及任何不良事件。
结果
我们的分析纳入了12项研究，共1243例患者（DES组562例，BMS组681例）。结果表明，DES组颅内[比值比（OR）：0.23；95%置信区间（CI）：0.13至0.41；P＜0.00001]和椎动脉狭窄[OR：0.38；95%CI：0.20至0.72；P = 0.003]的支架内再狭窄率均显著低于BMS组。此外，DES组椎动脉狭窄病例的术后中风率显著降低（OR：0.38；95%CI：0.16至0.90；P = 0.03），颅内动脉狭窄比较中未发现显著差异（OR：0.63；95%CI：0.20至1.95；P = 0.42）。该研究还表明，在所研究的情况下，两组在支架内再狭窄症状、手术成功率、死亡率、不良反应和围手术期并发症方面无显著差异。
结论
比较表明，与BMS相比，DES显著降低了椎动脉狭窄患者的支架内再狭窄和术后中风风险。对于颅内和椎动脉狭窄，DES和BMS的安全性相当。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=439967。
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