目的:血管内治疗(EVT)被推荐用于急性大血管闭塞(LVO)在美国国立卫生研究院卒中量表(NIHSS)评分≤6分的患者中,与医疗管理(MM)相比,其疗效和安全性尚不清楚.这项荟萃分析比较了2015年至2023年之间接受大血管闭塞轻度卒中治疗的患者的EVT与医学MM,这是第一个随机对照试验发表后的结果。
方法:生物医学数据库搜索(开始至2023年3月21日)检索了报告良好功能结果(改良的Rankin量表[mRS]0-1)和功能独立性(mRS0-2)的文章,90天死亡率和症状性颅内出血(sICH)。我们遵循系统审查和荟萃分析指南(PRISMA)的首选报告项目,以保持荟萃分析的方法学严谨和透明度。
结果:我们对22项研究(4,985名患者)进行了荟萃分析,发现所有组的良好功能结局和独立性没有显着差异。然而,在2015年至2023年接受治疗的患者中,EVT显示出90天死亡的风险较高(赔率[OR]=1.84,95%置信区间[CI][1.10,3.07],p=0.02)和sICH(OR=3.36,95%CI[1.96,6.66],p<0.01)。EVT与前循环sICH升高相关(OR=2.94,95CI[1.82,4.74],p<0.01),与近端无关(OR=2.20,95CI[1.04,4.69],p=0.04)或远端(OR=3.44,95CI[1.43,8.32],p<0.01)闭塞的位置。在症状发作后6小时内治疗的患者或NHISS≤5的患者中,EVT与sICH发生率升高相关。
结论:在2015年至2023年接受治疗的患者中,EVT和MM在急性LVO轻度卒中的疗效上没有差异;MM具有更好的安全性结果。严格的随机对照试验是必要的。
OBJECTIVE: Endovascular therapy (EVT) is recommended for patients with acute large-vessel occlusion (LVO) However, its efficacy and safety compared to medical management (MM) in patients with a National Institutes of Health Stroke Scale (NIHSS) score of ≤6 remains unclear. This meta-analysis compared EVT with medical MM in patients with large vessel occlusion mild stroke treated between 2015 and 2023, following the publication of the first randomized controlled trial.
METHODS: Biomedical database searches (inception to March 21, 2023) retrieved articles reporting favorable functional outcome(modified Rankin Scale [mRS] 0-1) and functional independence (mRS 0-2), 90-day mortality and symptomatic intracranial hemorrhage (sICH). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) to maintain methodological rigor and transparency in our meta-analysis.
RESULTS: We conducted a meta-analysis of 22 studies (4,985 patients) to reveal no significant differences in favorable functional outcomes and independence across all groups. However, in patients treated between 2015 and 2023, EVT exhibited a higher risk of 90-day mortality (Odds Ratio [OR] = 1.84, 95% Confidence Interval [CI] [1.10, 3.07], p = 0.02) and sICH (OR = 3.36, 95% CI [1.96, 6.66], p < 0.01). EVT correlated with elevated sICH in the anterior circulation (OR=2.94, 95%CI [1.82, 4.74], p<0.01) regardless of the proximal (OR=2.20, 95%CI [1.04, 4.69], p=0.04) or distal (OR=3.44, 95%CI [1.43, 8.32], p<0.01) location of the occlusion. EVT correlated with elevated sICH rates in patients treated within 6 hours of symptom onset or those with NHISS≤5.
CONCLUSIONS: In patients treated between 2015 and 2023, EVT and MM did not differ in efficacy in acute LVO mild stroke; MM associated with better safety outcomes. Rigorous randomized controlled trials are warranted.