颅内动脉粥样硬化患者颅内支架置入术与单纯药物治疗的比较:一项最新的荟萃分析

Adam A Dmytriw, Jerry Ku, Ahmed Y Azzam, Osman Elamin, Nicole Cancelliere, Anish Kapadia, James D Rabinov, Christopher J Stapleton, Robert W Regenhardt, Vitor Mendes Pereira, Aman B Patel, Victor X D Yang
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引用次数: 0

摘要

目的:中风是全球第二大死亡原因。颅内动脉粥样硬化性狭窄(ICAS)在西方国家占缺血性中风的10-15%,在亚洲国家高达47%。ICAS患者卒中复发的风险特别高。本荟萃分析的目的是重新评估复发性卒中、短暂性脑缺血发作(TIA)和支架置入治疗症状性ICAS与最佳医疗管理的其他结果。方法:根据系统评价和荟萃分析首选报告项目(PRISMA)指南制定先验搜索方案。检索了OVID Medline、Embase、Web of Science和Cochrane Library数据库,检索时间从建站到2022年8月14日。结果:本荟萃分析纳入4项随机对照试验(Rcts),共991例患者。参与者的平均年龄为57岁。颅内支架术患者总数为495例,内科治疗496例。纳入的研究发表于2011年至2022年之间。两项研究在美国进行,另外两项在中国进行。所有纳入的研究都比较了颅内支架置入术与药物治疗。结论:在伴有严重颅内动脉粥样硬化症状的缺血性脑卒中患者中,30天缺血性脑卒中、30天脑出血、1年内境内脑卒中或死亡率均倾向于单纯药物治疗而不进行颅内支架置入术。最后一次随访时同一区域卒中的风险、最后一次随访时致残性卒中的风险和死亡率对两组都没有显著的好处。动脉粥样硬化的颅内支架植入与药物治疗相比没有显著的疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intracranial stenting compared to medical treatment alone for intracranial atherosclerosis patients: An updated meta-analysis.

Objective: Stroke is the second-leading cause of death globally. Intracranial atherosclerotic stenosis (ICAS) represents 10-15% of ischemic strokes in Western countries and up to 47% in Asian countries. Patients with ICAS have an especially high risk of stroke recurrence. The aim of this meta-analysis is to reassess recurrent stroke, transient ischemic attack (TIA), and other outcomes with stenting versus best medical management for symptomatic ICAS.

Methods: The search protocol was developed a priori according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The OVID Medline, Embase, Web of Science, and Cochrane Library databases were searched from inception to August 14th, 2022.

Results: This Meta-analysis Included Four Randomized Controlled Trials (Rcts), With A Total Number Of 991 Patients. The Mean Age Of Participants Was 57 Years. The Total Number Of Intracranial Stenting Patients Was 495, And The Number Of Medical Treatment Patients Was 496. The Included Studies Were Published Between 2011 And 2022. Two Studies Were Conducted In The Usa, And The Other Two In China. All Included Studies Compared Intracranial Stenting To Medical Treatment For Icas.

Conclusions: In patients with ischemic stroke due to symptomatic severe intracranial atherosclerosis, the rate of 30-day ischemic stroke, 30-day intracerebral hemorrhage, one-year stroke in territory or mortality favored the medical treatment alone without intracranial stenting. The risk of same-territory stroke at last follow-up, disabling stroke at last follow-up, and mortality did not significantly favor either group. Intracranial stenting for atherosclerosis did not result in significant benefit over medical treatment.

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