Cem Bilgin, Mohamed Ibrahim, Sherief Ghozy, Mohamed Sobhi Jabal, Mostafa Shehata, Hassan Kobeissi, Ramanathan Kadirvel, Waleed Brinjikji, Alejandro A Rabinstein, David F Kallmes
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Randomized controlled trials (RCTs) investigating the role of modern MT in acute ischemic stroke were screened. Posterior circulation and large-core infarct trials were excluded from the study. The data regarding excellent outcomes (mRS: 0-1), functional independence (mRS: 0-2), and reperfusion were collected.</p><p><strong>Results: </strong>Twenty-two RCTs comprising 5692 patients were included in the meta-analysis. The overall mRS 0-1 rate was 31.24% (95% CI = 26.95-36.2). The rate of successful reperfusion was 81.8% (95% CI = 77.93-85.86). MT achieved significantly higher rates of mRS 0-1 compared to standard care alone (OR = 2.04; 95% CI = 1.64-2.55; P-value < 0.001), with no heterogeneity detected among studies (I<sup>2</sup>= 0%; P-value = 0.52). The direct MT and MT plus intravenous thrombolytic treatment groups' excellent outcome rates were comparable (OR = 0.98; 95% CI = 0.82-1.18; P-value = 0.863). 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引用次数: 0
摘要
背景：改良兰金量表（mRS）评分≤2（功能独立）一直是现代机械血栓切除术（MT）试验中最常见的主要终点。然而，与 mRS 0-1 分不同，mRS 2 分表示残疾。目的：调查机械取栓术后的优良预后（mRS 0-1）率：我们系统地检索了 Ovid MEDLINE、Ovid EMBASE、Cochrane Central Register of Controlled Trials、Scopus 和 Web of Science 数据库。筛选了研究现代 MT 在急性缺血性中风中作用的随机对照试验 (RCT)。研究排除了后循环和大核心梗死试验。研究收集了有关极佳疗效（mRS：0-1）、功能独立性（mRS：0-2）和再灌注的数据：荟萃分析纳入了 22 项研究，共 5692 名患者。总体 mRS 0-1 比率为 31.24% (95% CI = 26.95-36.2)。再灌注成功率为 81.8%（95% CI = 77.93-85.86）。与单纯标准护理相比，MT的mRS 0-1率明显更高（OR = 2.04；95% CI = 1.64-2.55；P值2= 0%；P值= 0.52）。直接MT组和MT加静脉溶栓治疗组的优良预后率相当（OR=0.98；95% CI=0.82-1.18；P值=0.863）。此外，抽吸和支架回取血栓切除技术也提供了相似的优良预后率（OR = 0.76；95% CI = 0.55-1.05；P 值 = 0.141）：我们的研究结果证明，采用更严格的良好功能预后定义，MT比标准治疗更有优势。在接受 MT 治疗的大动脉闭塞患者中，近三分之一的患者在 90 天后无残疾。虽然这很了不起，但我们的结果也表明，仅靠再灌注往往不足以预防残疾，因此需要更好的神经保护策略。
Disability-free outcomes after mechanical thrombectomy: A systematic review and meta-analysis of the randomized controlled trials.
Background: The modified Rankin Scale (mRS) score of ≤2 (functional independence) has been the most common primary endpoint of modern mechanical thrombectomy (MT) trials. However, unlike mRS 0-1, mRS score of 2 indicates disability. An important proportion of the mRS 2 patients are home dependent and report a significant decrease in their quality of life.
Purpose: To investigate excellent outcome (mRS 0-1) rates after MT.
Methods: We systematically searched Ovid MEDLINE, Ovid EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases. Randomized controlled trials (RCTs) investigating the role of modern MT in acute ischemic stroke were screened. Posterior circulation and large-core infarct trials were excluded from the study. The data regarding excellent outcomes (mRS: 0-1), functional independence (mRS: 0-2), and reperfusion were collected.
Results: Twenty-two RCTs comprising 5692 patients were included in the meta-analysis. The overall mRS 0-1 rate was 31.24% (95% CI = 26.95-36.2). The rate of successful reperfusion was 81.8% (95% CI = 77.93-85.86). MT achieved significantly higher rates of mRS 0-1 compared to standard care alone (OR = 2.04; 95% CI = 1.64-2.55; P-value < 0.001), with no heterogeneity detected among studies (I2= 0%; P-value = 0.52). The direct MT and MT plus intravenous thrombolytic treatment groups' excellent outcome rates were comparable (OR = 0.98; 95% CI = 0.82-1.18; P-value = 0.863). Also, aspiration and stent retriever thrombectomy techniques provided similar excellent outcome rates (OR = 0.76; 95% CI = 0.55-1.05; P-value = 0.141).
Conclusions: Our results prove the additional benefit of MT over standard care, using a stricter definition for favorable functional outcome. Nearly one-third of patients presenting with large artery occlusion and treated with MT had no disability at 90 days. While this is remarkable, our results also indicate that reperfusion alone is often not enough to prevent disability and underline the need for better neuroprotection strategies.
期刊介绍：
Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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