Endovascular thrombectomy for large-core stroke: a meta-analysis with trial sequential analysis.

IF 1 4区医学 Q4 NEUROSCIENCES

Arquivos de neuro-psiquiatria Pub Date : 2025-05-01 Epub Date: 2025-05-13 DOI:10.1055/s-0045-1806827

Marco Antonnio Rocha Dos Santos, Pierludovico Moro, Abner Lucas Balduino de Souza, Lauren Nirta, Thaís Pereira Mendes, Laura de Lima Xavier, Ming-Chieh Ding

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引用次数: 0

Abstract

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: n = 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.

查看原文本刊更多论文

大核卒中的血管内血栓切除术：一项荟萃分析与试验序列分析。

最近的研究报道，血管内血栓切除术（ET）可能改善大核卒中的神经预后。我们进行了一项系统回顾和荟萃分析，以比较大核卒中患者中ET和最佳药物治疗的总疗效和安全性。我们检索了PubMed/MEDLINE， Scopus和Cochrane数据库，从成立到2023年11月。纳入标准是随机对照试验（rct），比较大核心卒中患者在症状出现24小时内的ET和最佳药物治疗（Alberta stroke Program早期计算机断层扫描评分[ASPECTS]灌注成像50 mL）。我们纳入了6个rtc，包括1887例患者（ET组：n = 945）。血管内取栓与良好的神经预后相关(优势比[OR]: 2.92；95%可信区间[95% ci]: 2.17-3.93)或独立行走(or: 2.22；95%置信区间:1.72—-2.86)。试验序贯分析证实了有利于ET的良好神经学预后具有显著的统计学意义。血管内取栓与颅内出血的高风险相关(OR: 2.65；95%CI: 1.35-5.22)和症状性颅内出血(OR: 1.83；95%置信区间:1.14—-2.94)。两组之间在死亡率和开颅减压术方面没有差异。接受非对比计算机断层扫描（CT）和CT血管造影（CTA）扫描的患者分别进行分析，显示出良好的神经系统预后，与接受其他成像方式的患者相当(OR: 3.24；95%置信区间:1.52—-6.92)。血管内血栓切除术与大核急性缺血性脑卒中患者良好的神经预后和独立行走相关。然而，它也与颅内出血的风险增加有关。非对比头部CT与CTA扫描可能适用于筛查接受ET的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arquivos de neuro-psiquiatria 医学-精神病学

CiteScore

2.10

自引率

7.10%

发文量

262

审稿时长

4-8 weeks

期刊介绍： Arquivos de Neuro-Psiquiatria is the official journal of the Brazilian Academy of Neurology. The mission of the journal is to provide neurologists, specialists and researchers in Neurology and related fields with open access to original articles (clinical and translational research), editorials, reviews, historical papers, neuroimages and letters about published manuscripts. It also publishes the consensus and guidelines on Neurology, as well as educational and scientific material from the different scientific departments of the Brazilian Academy of Neurology. The ultimate goals of the journal are to contribute to advance knowledge in the areas of Neurology and Neuroscience, and to provide valuable material for training and continuing education for neurologists and other health professionals working in the area. These goals might contribute to improving care for patients with neurological diseases. We aim to be the best Neuroscience journal in Latin America within the peer review system.