Wu Yuelu, Su Ruifeng, Feng Xinggang, Mao An, Nguyen Thanh N, Cai Lingyu, Li Qi, Guo Qifeng, Yang Qingwu, Sang Hongfei, Yang Guangui, Qiu Zhongming, Xie Fang, Li Chaoqun
Zhejiang Chinese Medical University, Hangzhou, 310000, China.
Department of Neurology, The 903Rd Hospital of The Chinese People's Liberation Army, Hangzhou, 310000, China.
J Neurol. 2025 Jan 7;272(1):101. doi: 10.1007/s00415-024-12842-y.
Randomized controlled trials have demonstrated the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute large vessel occlusion stroke. However, its long-term benefits remain uncertain. Therefore, this study aimed to investigate the long-term clinical outcomes of EVT.
We searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify relevant literature pertaining to patients with acute ischemic stroke who were treated with EVT plus medical management (MM) compared with MM alone, until August, 31, 2024. The primary outcome was functional independence (defined as a score of 0 to 2 on the modified Rankin scale [mRS]) at 12 months or beyond, while the safety outcome was mortality at 12 months or longer. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models. This study was registered on the International Prospective Register of Systematic Reviews on June 15, 2024 (PROSPERO, CRD42024554043).
A total of 4546 articles were obtained through the search. After excluding those that did not meet the inclusion criteria, 9 randomized controlled trials with 3358 patients (1821 and 1537 assigned to EVT + MM and MM alone group, respectively) were included in this analysis. The EVT + MM group had a higher proportion of functional independence (32.9% vs 18.2%, risk ratio 2.07, 95% confidence interval 1.50-2.87, P < 0.001) and lower mortality (34.1% vs 39.7%, risk ratio 0.86, 95% confidence interval 0.78-0.94, P = 0.001) compared to the MM group.
Endovascular thrombectomy was associated with improved functional outcomes and reduced mortality in acute large vessel occlusion stroke patients and presented a long-term favorable effect.
随机对照试验已证明血管内血栓切除术（EVT）对急性大血管闭塞性卒中患者的有效性和安全性。然而，其长期益处仍不确定。因此，本研究旨在探讨EVT的长期临床结局。
我们检索了PubMed、Embase、Cochrane图书馆和Web of Science数据库，以识别与接受EVT联合药物治疗（MM）与单纯MM治疗的急性缺血性卒中患者相关的文献，检索截止至2024年8月31日。主要结局是12个月及以后的功能独立性（定义为改良Rankin量表[mRS]评分为0至2分），而安全性结局是12个月及更长时间的死亡率。效应量计算为随机效应或固定效应模型下的风险比（RR）。本研究于2024年6月15日在国际系统评价前瞻性注册库注册（PROSPERO，CRD42024554043）。
通过检索共获得4546篇文章。排除不符合纳入标准的文章后，本分析纳入了9项随机对照试验，共3358例患者（分别有1821例和1537例被分配至EVT+MM组和单纯MM组）。与MM组相比，EVT+MM组功能独立性比例更高（32.9%对18.2%，风险比2.07，95%置信区间1.50 - 2.87，P < 0.001），死亡率更低（34.1%对39.7%，风险比0.86，95%置信区间0.78 - 0.94，P = 0.001）。
血管内血栓切除术与急性大血管闭塞性卒中患者功能结局改善和死亡率降低相关，并呈现出长期的有益效果。
