非对比与灌注CT在延长时间窗口内选择血管内治疗:系统回顾/荟萃分析

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging Pub Date : 2023-09-07 DOI:10.1111/jon.13152

Xue Bai, Yao Zhang, Yi Sui

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引用次数: 0

摘要

背景与目的非对比CT (NCCT)对延长时间窗内血管内治疗(EVT)适格性的影响仍有待阐明。我们试图评估NCCT与CT灌注(CTP)在选择急性缺血性卒中(AIS)患者发病后6-24小时进行EVT的有效性和安全性。方法检索PubMed、Embase和Cochrane文库，从开始到2022年8月31日，以确定所有报告AIS患者在延长时间窗口内90天EVT结果的研究。采用随机效应模型对合并风险比(RR)进行荟萃分析，95%置信区间(CI)。用于评估疗效的主要终点是良好的功能独立性，定义为90天时0-2的修正Rankin量表评分。次要结局包括再灌注成功、症状性颅内出血(siich)和90天死亡率。结果我们纳入了4项非随机研究，共2685例患者。90天功能独立良好的结局(RR = 0.98;95% ci: 0.88-1.07;i2 = 0%;p = 0.62)，再灌注成功(RR = 0.98;95% ci: 0.93-1.03;i2 = 50.5%;p = 0.11)， siich (RR = 1.11;95% ci: 0.55-2.21;i2 = 49.4%;p = 0.12)，或90天死亡率(RR = 1.18;95% ci: 0.99-1.40;i2 = 0%;P = 0.42)，两组间差异无统计学意义。结论NCCT与CTP在选择EVT患者时同样有效。

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Noncontrast versus perfusion CT to select endovascular therapy in an extended time window: Systematic review/meta-analysis

Background and Purpose

The effect of noncontrast CT (NCCT) on the eligibility for endovascular therapy (EVT) in an extended time window remains to be elucidated. We sought to assess the efficacy and safety of NCCT in comparison with CT perfusion (CTP) in selecting patients with acute ischemic stroke (AIS) for EVT 6-24 hours after onset.

Methods

PubMed, Embase, and Cochrane libraries were searched from inception to August 31, 2022, to identify all studies reporting 90-day outcomes of EVT in patients with AIS in an extended time window. A meta-analysis was performed for the pooled risk ratio (RR) with 95% confidence interval (CI) using a random-effects model. The primary outcome used to assess efficacy was good functional independence, defined as a modified Rankin Scale score of 0-2 at 90 days. Secondary outcomes included successful reperfusion, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days.

Results

We included four nonrandomized studies with a total of 2685 patients. The outcomes of good functional independence at 90 days (RR = 0.98; 95% CI: 0.88-1.07; I² = 0%; p = .62), successful reperfusion (RR = 0.98; 95% CI: 0.93-1.03; I² = 50.5%; p = .11), sICH (RR = 1.11; 95% CI: 0.55-2.21; I² = 49.4%; p = .12), or mortality at 90 days (RR = 1.18; 95% CI: 0.99-1.40; I² = 0%; p = .42) did not differ significantly between the two groups.

Conclusions

These findings suggest that NCCT is as effective as CTP in selecting patients for EVT in an extended time window.

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!