目的:使用血管内治疗(EVT)已成为急性缺血性卒中(AIS)临床治疗的广泛策略。然而,动脉注射替罗非班联合EVT治疗AIS仍然是一个有争议的话题.这项荟萃分析是为了评估这种治疗方法的安全性和有效性。
方法:相关研究是通过在Pubmed,EMBASE,WebofScience,和Cochrane图书馆数据库,涵盖2010年1月至2023年1月发表的文章。疗效结果包括有利的功能结果,再通率,和安全性结局,包括死亡率和有症状的颅内出血(sICH)。
结果:荟萃分析包括来自13项研究的数据,其中包括1项随机对照试验(RCT),7项前瞻性队列研究,和5项回顾性队列研究,共包括3477名患者。研究结果表明,动脉内(IA)替罗非班+EVT治疗AIS与有利功能结局的显着改善相关(OR,1.21;95CI,1.05-1.40;P=0.009)和再通率(OR,1.33;95CI,1.06-1.65;P=0.01),以及死亡率的显著降低(OR,0.65;95CI,0.53-0.79;P=0.0001)。亚组分析显示,EVT后给予维持剂量的静脉内(IV)替罗非班与改善患者功能结局和降低死亡率显着相关。此外,sICH的发病率没有增加(OR,0.92;95CI,0.71-1.20;P=0.54)。
结论:动脉内替罗非班联合EVT是AIS的有效和安全的治疗策略,术后维持剂量的静脉注射替罗非班可能比仅IA更有效。
OBJECTIVE: The use of endovascular therapy (EVT) has become a widespread strategy for the clinical management of acute ischemic stroke (AIS). However, the combination of arterial injection of tirofiban with EVT for AIS continues to be a subject of controversy. This meta-analysis was conducted to assess the safety and efficacy of this treatment approach.
METHODS: Relevant studies were identified through a systematic literature search in Pubmed, EMBASE, Web of Science, and Cochrane Library databases, covering articles published from January 2010 to January 2023. The efficacy outcomes included favorable functional outcomes, recanalization rates, and safety outcomes including mortality and symptomatic intracranial hemorrhage (sICH).
RESULTS: The meta-analysis consisted of data from 13 studies, which included 1 randomized controlled trial (RCT), 7 prospective cohort studies, and 5 retrospective cohort studies, encompassing a total of 3477 patients. The study results indicate that the intra-arterial (IA) tirofiban+EVT for AIS is associated with significant improvements in favorable functional outcomes (OR, 1.21; 95%CI, 1.05-1.40; P = 0.009) and recanalization rate (OR, 1.33; 95%CI, 1.06-1.65; P = 0.01), as well as significant reductions in mortality rates (OR, 0.65; 95%CI, 0.53-0.79; P = 0.0001). Subgroup analysis revealed that administering a maintenance dose of intravenous (IV) tirofiban post-EVT was significantly associated with improved functional outcomes and reduced mortality in patients. In addition, there was no increase in the incidence of sICH (OR, 0.92; 95%CI, 0.71-1.20; P = 0.54).
CONCLUSIONS: The administration of Intra-arterial tirofiban combined with EVT is an effective and safe treatment strategy for AIS, and postoperative maintenance doses of intravenous tirofiban may be more effective than IA only.