Bhatia Shovan, Nouduri Sirisha T, Sankar Akshay, Kann Michael R, Hardi Angela, Hudson Joseph S, Al-Bayati Alhamza R, Nogueira Raul G, Lang Michael J, Gross Bradley A
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
Becker Medical Library, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Stroke Cerebrovasc Dis. 2025 Feb;34(2):108208. doi: 10.1016/j.jstrokecerebrovasdis.2024.108208. Epub 2024 Dec 22.
Anterior cerebral artery (ACA) occlusions account for up to 4 % of all acute ischemic strokes and may lead to debilitating outcomes. While endovascular thrombectomy (EVT) is a well-established treatment for large vessel occlusions, its efficacy and safety for primary ACA occlusions remains unclear. This systematic review and meta-analysis aims to address this gap by evaluating the clinical outcomes, safety, and efficacy of EVT in the treatment for primary ACA occlusions.
Following PRISMA guidelines, five databases were queried from database inception until April 2024 for studies describing the use of EVT for acute ischemic primary ACA occlusions. Following abstract, title, and full text-screening, data on patient demographics, clinical presentation, procedural details, and surgical outcomes were extracted from included articles. Primary outcomes were successful reperfusion (modified-Treatment in Cerebral Infarction (mTICI) score 2b-3), and favorable functional outcomes (3-month modified Rankin Scale (mRS) scores 0-2). Secondary outcomes included 3-month mortality rates and procedural complication rates. Meta-analysis was performed using a random-effects model, with heterogeneity assessed by the Higgins index (I²>50 %).
Ten studies met eligibility criteria, encompassing a total of 265 patients with complete clinical and outcome data. Across the pooled meta-analysis, the rate of successful reperfusion (mTICI ≥ 2b) was 0.78 (95 % CI: 0.67-0.86) and the rate of 3-month mRS score 0-2 was 0.41 (95 % CI: 0.33-0.51). Pooled meta-analysis of secondary outcomes analysis revealed a 3-month mortality rate of 0.20 (95 % CI: 0.15-0.26), while the rate of symptomatic intracerebral hemorrhage was 0.04 (95 % CI: 0.02-0.08).
Our findings demonstrate that while successful reperfusion can be achieved with low complication rates, primary ACA occlusions treated with EVT are associated with high morbidity and mortality.
大脑前动脉（ACA）闭塞占所有急性缺血性卒中的比例高达4%，可能导致使人衰弱的后果。虽然血管内血栓切除术（EVT）是治疗大血管闭塞的成熟方法，但其对原发性ACA闭塞的疗效和安全性仍不明确。本系统评价和荟萃分析旨在通过评估EVT治疗原发性ACA闭塞的临床结局、安全性和疗效来填补这一空白。
按照PRISMA指南，从数据库建立至2024年4月查询了五个数据库，以获取描述将EVT用于急性缺血性原发性ACA闭塞的研究。经过摘要、标题和全文筛选后，从纳入的文章中提取了患者人口统计学、临床表现、手术细节和手术结局的数据。主要结局为成功再灌注（改良脑梗死治疗（mTICI）评分2b - 3）和良好的功能结局（3个月改良Rankin量表（mRS）评分0 - 2）。次要结局包括3个月死亡率和手术并发症发生率。采用随机效应模型进行荟萃分析，通过Higgins指数评估异质性（I²>50%）。
十项研究符合纳入标准，共纳入265例具有完整临床和结局数据的患者。在汇总的荟萃分析中，成功再灌注（mTICI≥2b）率为0.78（95%CI：0.67 - 0.86），3个月mRS评分0 - 2率为0.41（95%CI：0.33 - 0.51）。次要结局分析的汇总荟萃分析显示，3个月死亡率为0.20（95%CI：0.15 - 0.26），而症状性脑出血率为0.04（95%CI：0.02 - 0.08）。
我们的研究结果表明，虽然EVT可实现低并发症率的成功再灌注，但治疗原发性ACA闭塞会带来较高的发病率和死亡率。
