血管内治疗与最佳药物治疗对伴有远端中等血管闭塞的急性缺血性卒中的疗效比较：一项系统评价和荟萃分析。

Endovascular therapy versus best medical care for acute ischemic stroke with distal medium vessel occlusion: a systematic review and meta-analysis.

作者信息

Wang Ziyue, Li Jiacheng, Kong Qianqian, Yan Hao, Zhang Yi, Zhou Xirui, Yu Zhiyuan, Huang Hao, Luo Xiang

机构信息

Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Ann Med. 2025 Dec;57(1):2447407. doi: 10.1080/07853890.2024.2447407. Epub 2025 Jan 3.

BACKGROUND

With the refinement of catheter technology, distal medium vessel occlusions (DMVOs) are now viewed as amenable to endovascular treatment (EVT) but its efficacy and safety remains unclear in AIS patients with DMVO.

METHODS

We conducted a systematic search of PubMed, Embase databases and Cochrane Library up to December 2023 using keywords to identify studies comparing EVT versus BMT in AIS with DMVOs. The assessed clinical outcomes were excellent functional outcome, good functional outcome, 90-day mortality, symptomatic intracranial hemorrhage (sICH), and early neurological improvement (ENI) after treatment.

RESULTS

Overall, 31 studies were included. There were no significant differences in excellent functional outcome (OR: 1.21, 95% CI: 0.99-1.47), good functional outcome (OR: 1.03, 95% CI: 0.82-1.30) and 90-day mortality (OR: 1.17, 95% CI: 0.84-1.62). Additionally, EVT led to higher sICH (OR: 1.64, 95% CI: 1.09-2.47) and better ENI (OR: 1.50, 95% CI: 1.02-2.19) compared to BMT. In individuals with M2 occlusion receiving EVT showed better excellent functional outcomes (OR: 1.48, 95% CI: 1.07-2.03). Those patients with PCA occlusion showed no significant difference in functional outcomes. In individuals with ACA occlusion, EVT resulted in reduced functional independence (OR: 0.55, 95% CI: 0.31-0.98). For NIHSS < 6, BMT achieved better functional independence compared to EVT (OR: 0.71, 95% CI: 0.51-0.98) and EVT showed higher sICH (OR: 3.44, 95% CI: 1.42-8.31).

CONCLUSION

For patients with AIS and DMVO occlusion, EVT fails to improve functional prognosis while increasing sICH incidence. More randomized controlled trials are needed in the future to confirm these results.

背景

随着导管技术的不断完善，远端中等血管闭塞（DMVO）现在被认为适合进行血管内治疗（EVT），但其在急性缺血性卒中（AIS）合并DMVO患者中的疗效和安全性仍不明确。

方法

我们使用关键词对截至2023年12月的PubMed、Embase数据库和Cochrane图书馆进行了系统检索，以识别比较AIS合并DMVO患者中EVT与最佳药物治疗（BMT）的研究。评估的临床结局包括良好功能结局、较好功能结局、90天死亡率、症状性颅内出血（sICH）以及治疗后的早期神经功能改善（ENI）。

结果

总体而言，共纳入31项研究。在良好功能结局（比值比[OR]：1.21，95%置信区间[CI]：0.99 - 1.47）、较好功能结局（OR：1.03，95% CI：0.82 - 1.30）和90天死亡率（OR：1.17，95% CI：0.84 - 1.62）方面无显著差异。此外，与BMT相比，EVT导致更高的sICH（OR：1.64，95% CI：1.09 - 2.47）和更好的ENI（OR：1.50，95% CI：1.02 - 2.19）。在M2段闭塞的个体中，接受EVT显示出更好的良好功能结局（OR：1.48，95% CI：1.07 - 2.03）。那些大脑后动脉（PCA）闭塞的患者在功能结局方面无显著差异。在大脑前动脉（ACA）闭塞的个体中，EVT导致功能独立性降低（OR：0.55，95% CI：0.31 - 0.98）。对于美国国立卫生研究院卒中量表（NIHSS）评分<6的患者，与EVT相比，BMT实现了更好的功能独立性（OR：0.71，95% CI：0.51 - 0.98），且EVT显示出更高的sICH（OR：3.44，95% CI：1.42 - 8.31）。