Santos Marco Antonnio Rocha Dos, Moro Pierludovico, Souza Abner Lucas Balduino de, Nirta Lauren, Mendes Thaís Pereira, Xavier Laura de Lima, Ding Ming-Chieh
Universidade do Planalto Catarinense, Lages SC, Brazil.
Università La Sapienza, Department of Human Human Neuroscience, Roma LAZ, Italy.
Arq Neuropsiquiatr. 2025 May;83(5):1-12. doi: 10.1055/s-0045-1806827. Epub 2025 May 13.
Recent studies have reported that endovascular thrombectomy (ET) may improve neurological outcomes in large-core stroke.We performed a systematic review and meta-analysis to compare the pooled efficacy and safety of ET and of the best medical treatment among patients with large-core stroke.We searched the PubMed/MEDLINE, Scopus, and Cochrane databases from inception to November 2023. The inclusion criteria were randomized controlled trials (RCTs) comparing ET and the best medical treatment available among patients with large-core stroke (Alberta Stroke Program Early Computed Tomography Score [ASPECTS] < 6 or ischemic core > 50 mL on perfusion imaging) within 24 hours of symptom onset.We included 6 RTCs comprising 1,887 patients (ET group: = 945). Endovascular thrombectomy was associated with good neurological outcomes (odds ratio [OR]: 2.92; 95% confidence interval [95%CI]: 2.17-3.93), or independent walking (OR: 2.22; 95%CI: 1.72-2.86). Trial sequential analysis confirmed a robust statistical significance for good neurological outcomes favoring ET. Endovascular thrombectomy was associated with higher risks of developing intracranial bleeding (OR: 2.65; 95%CI: 1.35-5.22) and symptomatic intracranial bleeding (OR: 1.83; 95%CI: 1.14-2.94). There were no differences between the groups regarding mortality or decompressive craniectomy. Patients submitted to non-contrast computed tomography (CT) with CT angiography (CTA) scans were analyzed separately and showed good neurological outcomes, comparable to those of the patients submitted to other imaging modalities (OR: 3.24; 95%CI: 1.52-6.92).Endovascular thrombectomy was associated with good neurological outcomes and independent walking in patients with large-core acute ischemic stroke. However, it was also associated with an increased risk of developing intracranial bleeding. Non-contrast head CT with CTA scans may be appropriate for screening patients to undergo ET.
近期研究报告称，血管内血栓切除术（ET）可能改善大核心梗死灶性卒中患者的神经功能预后。我们进行了一项系统评价和荟萃分析，以比较大核心梗死灶性卒中患者中ET与最佳药物治疗的综合疗效和安全性。我们检索了从数据库建立至2023年11月的PubMed/MEDLINE、Scopus和Cochrane数据库。纳入标准为在症状发作24小时内比较ET与大核心梗死灶性卒中患者（阿尔伯塔卒中项目早期计算机断层扫描评分[ASPECTS]<6或灌注成像显示缺血核心>50 mL）现有最佳药物治疗的随机对照试验（RCT）。我们纳入了6项RCT，共1887例患者（ET组：n = 945）。血管内血栓切除术与良好的神经功能预后相关（比值比[OR]：2.92；95%置信区间[95%CI]：2.17 - 3.93），或与独立行走相关（OR：2.22；95%CI：1.72 - 2.86）。序贯试验分析证实，在良好神经功能预后方面，支持ET具有显著统计学意义。血管内血栓切除术与发生颅内出血（OR：2.65；95%CI：1.35 - 5.22）和症状性颅内出血（OR：1.83；95%CI：1.14 - 2.94）的较高风险相关。两组在死亡率或减压性颅骨切除术方面无差异。对接受非增强计算机断层扫描（CT）及CT血管造影（CTA）扫描的患者进行单独分析，结果显示其神经功能预后良好，与接受其他成像方式的患者相当（OR：3.24；95%CI：1.52 - 6.92）。血管内血栓切除术与大核心急性缺血性卒中患者的良好神经功能预后和独立行走相关。然而，它也与发生颅内出血的风险增加相关。非增强头部CT联合CTA扫描可能适合用于筛选接受ET的患者。
