串联闭塞情况下紧急颈动脉支架植入术的抗血小板方案简介。系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2024-10-19 DOI:10.1016/j.clineuro.2024.108595

Gianluca De Rubeis , Luca Prosperini , Stefano Badia , Sebastiano Fabiano , Luca Bertaccini , Andrea Wlderk , Francesca Romana Pezzella , Valeria Caso , Luca Saba , Enrico Pampana

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引用次数: 0

摘要

目的：研究串联闭塞的脑卒中患者在接受机械血栓切除术（MT）后紧急进行颈动脉支架植入术的最佳抗血小板治疗方案（APTR）：在Pubmed/OVID/Cochran's CENTRAL数据库中对2015年至2022年的研究进行了文献检索。记录了患者特征、抗血小板方案类型、mTICI、90 天-mRS、急性支架内血栓形成（AIST）、死亡率、颅内出血（ICH）和样本量。排除标准为：非英语文献、样本量小于 5 例患者、接受过其他抗凝剂/抗血小板治疗、在一个研究臂中 100% 植入支架。研究采用 MINORS/GRADE 进行评估。采用随机效应模型进行了元分析和元回归。研究结果包括结果：共检索到 524 项研究。应用排除标准后，最终纳入 19/534 项研究（3.6%），涉及 880 名患者（每篇文章 46.3 名患者）。mRS的I^2和Q's Cochrane分别为86.4%和132.5，死亡的I^2和Q's Cochrane分别为19.9%和17.5，急性支架内血栓形成的I^2和Q's Cochrane分别为0%和9.4，颅内出血的I^2和Q's Cochrane分别为62.1%和39.7。阿司匹林亚组患者的功能独立率（mRS≤2）明显低于DAPT亚组患者（47 % [CI95 % 42.0 %-52.0 %] vs. 61.9 % [CI95 % 50.8-72.9]; p=0.0007；OR 0.75 [CI95 % 0.56-1.01], p=0.06）。与阿司匹林相比，DAPT能明显降低死亡率（8.6% [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012）。抗 GPIIb/IIIa 与 DAPT 相比，有增加死亡率概率的趋势（OR 1.88[CI95 % 0.93-3.86]，P=0.08。在治疗组中，AIST 和 ICH 之间无明显差异：结论：DAPT可增加mRS评分≤2分的机会，并降低死亡率。

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Profile of antiplatelet regimens for emergent carotid stenting in tandem occlusion. Systematic review and meta-analysis

Aim

To investigate the optimum antiplatelet therapy regimen (APTR) for emergent carotid artery stenting following mechanical thrombectomy (MT) in stroke patients with tandem occlusion.

Methods

A literature search was performed on Pubmed/OVID/Cochran's CENTRAL database for studies from 2015 to 2022. Patient characteristics, antiplatelet regimen type, mTICI, 90 days-mRS, acute in-stent thrombosis (AIST), mortality, intracranial hemorrhage (ICH), and sample size were recorded. Exclusion criteria were non-English literature, sample size < 5 patients, other anticoagulant/antiplatelet therapy, and 100 % stent insertion in one study arm. The studies were assessed using MINORS/GRADE. Meta-analysis and meta-regression with a random effects model were performed. The outcomes were: 90 days-mRS, death, AIST and ICH

Results

Five-hundred-twenty-four studies were retrieved. After applying the exclusion criteria, the final population included 19/534 studies (3.6 %) for 880 patients (46.3 per article). I^2 and Q’s Cochrane were 86.4 % and 132.5 for mRS, 19.9 % and 17.5 for death, 0 % and 9.4 for acute in-stent thrombosis and 62.1 % and 39.7 for intra-cranial haemorrhages, respectively.

Patients in the aspirin subgroup had a significantly lower rate of functional independence (mRS≤2) than those in the DAPT subgroup (47 % [CI95 % 42.0 %-52.0 %] vs. 61.9 % [CI95 % 50.8–72.9]; p=0.0007;OR 0.75[CI95 % 0.56–1.01], p=0.06). DAPT significantly decreased the death rate compared with aspirin (8.6 % [CI95 % 5.3 %-11.9 %] vs. 16.7 % [CI95 11.1 %-22.2 %]; p=0.0012). Anti-GPIIb/IIIa demonstrated a trend of increasing the probability of mortality versus DAPT (OR 1.88[CI95 % 0.93–3.86], p=0.08.

No significant differences were observed between AIST and ICH in the treatment groups.

Conclusion

DAPT may increases the chance of obtaining an mRS score ≤2 and reduces mortality.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.