颈动脉支架植入术与颈动脉内膜剥脱术后的脑缺血病变:系统回顾和元分析

Georgios Loufopoulos, Vasiliki Manaki, Panagiotis Tasoudis, Andreas Stylianos Meintanopoulos, George N Kouvelos, George Ntaios, Konstantinos Spanos
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摘要

背景:最近的随机对照试验表明,无症状颈动脉疾病患者接受颈动脉内膜剥脱术(CEA)或颈动脉支架植入术(CAS)后缺血性卒中的发生率相似,而CEA似乎是无症状颈动脉疾病患者的首选。本荟萃分析旨在评估这些手术后通过磁共振成像(MRI)检测到的无声脑微栓塞的发生率:使用 PubMed、Scopus 和 Cochrane 数据库进行了系统性检索,包括涉及接受 CEA 或 CAS 的无症状或无症状患者的比较研究,并报告了术后 MRI 中新的脑缺血病变。主要结果是新发现的脑缺血病变。所有结果的汇总效应估计值均采用随机效应模型计算。进行了预先指定的随机效应元回归和亚组分析,以研究调节变量对出现新的脑缺血病变的影响。结果:25 项研究共报告了 1827 例 CEA 和 1500 例 CAS 干预,均符合资格标准。与 CAS 相比,无论 MRI 评估时间(最初 24 小时;OR:0.33,95% CI:0.17-0.64,p<0.001)、(最初 72 小时,OR:0.25,95% CI:0.18-0.36,p<0.001)、(一般在术后一周内;OR:0.24,95% CI:0.17-0.34,p<0.001),CEA 术后新发脑缺血病变的发生率均显著降低。此外,CEA术后中风率(OR:0.38,95% CI:0.23-0.63,p<0.001)和出现对侧新的脑缺血病灶(OR:0.16,95% CI:0.08-0.32,p<0.001)的发生率也较低。基于研究设计和CAS期间使用栓塞保护装置的亚组分析表明,CEA术后新发病变的发生率一直较低:结论:与 CAS 相比,CEA 术后通过磁共振成像检测到的新发无声脑微栓塞率明显较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ischemic cerebral lesions after Carotid Stenting versus Carotid Endarterectomy: A Systematic review and Meta-Analysis
Background: Recent randomized controlled trials have demonstrated similar outcomes in terms of ischemic stroke incidence after carotid endarterectomy (CEA) or carotid artery stenting (CAS) in asymptomatic carotid disease, while CEA seems to be the first option for symptomatic carotid disease. The aim of this meta-analysis is to assess incidence of silent cerebral microembolization detected by Magnetic Resonance Imaging (MRI) following these procedures. Methods: A systematic search was conducted using PubMed, Scopus and Cochrane databases including comparative studies involving symptomatic or asymptomatic patients undergoing either CEA or CAS, and reporting on new cerebral ischemic lesions in post-operative MRI. The primary outcome was the newly detected cerebral ischemic lesions. Pooled effect estimates for all outcomes were calculated using the random-effects model. Pre-specified random effects meta-regression and subgroup analysis were conducted to examine the impact of moderator variables on the presence of new cerebral ischemic lesions. Results: 25 studies reporting on total 1827 CEA and 1500 CAS interventions fulfilled the eligibility criteria. The incidence of new cerebral ischemic lesions was significantly lower after CEA comparing to CAS, regardless of the time of MRI assessment (first 24 hours; OR: 0.33, 95% CI: 0.17-0.64, p<0.001), (the first 72 hours, OR: 0.25, 95% CI 0.18-0.36, p<0.001), (generally within a week after the operation; OR: 0.24, 95% CI: 0.17-0.34, p<0.001). Also, the rate of stroke (OR: 0.38, 95% CI: 0.23-0.63, p<0.001) and the presence of contralateral new cerebral ischemic lesions (OR: 0.16, 95% CI 0.08-0.32, p<0.001) were less frequent after CEA. Subgroup analysis based on the study design and the use of embolic protection device during CAS showed consistently lower rates of new lesions after CEA. Conclusions: CEA demonstrates significant lower rates of new silent cerebral microembolization, as detected by MRI in postoperative period, compared to CAS.
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