桥接还是不桥接：通过双中心队列研究和荟萃分析探讨静脉溶栓在大面积脑梗塞机械取栓术中的作用。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-11-09 DOI:10.1016/j.jstrokecerebrovasdis.2024.108115

Wang Chen MD , Lei Yang MD , Simeng Wang MD , Ji Liu MD , Mengen Wang MD , Jincheng Wu MD , Wei Qin MD , Xianjun Wang MD , Wenli Hu MD

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引用次数: 0

摘要

背景：在大面积脑梗死的机械取栓术（MT）之前进行静脉溶栓的有效性和安全性仍不确定。本研究比较了包括静脉溶栓的桥接式机械取栓术和不包括静脉溶栓的直接机械取栓术：方法：分析了298名前循环大面积脑梗塞患者的数据，这些患者通过非增强CT（ASPECTS 0-5）进行评估，并在两个中心的队列研究中接受了MT。主要结果集中在中风后90天的独立行走能力（修改后的Rankin量表评分0-3）。安全性结果包括实质出血（PH）率和死亡率。我们进行了一项敏感性分析，考虑到从症状发作到成像的时间应在 4.5 小时内。此外，我们还对涉及 3527 名患者的 17 项研究进行了荟萃分析，评估了干预措施的有效性和安全性，并对高质量研究（纽卡斯尔-渥太华量表评分 7-9 级）进行了进一步审查，以提高结果的稳健性：桥接 MT 组和直接 MT 组在 90 天独立行走方面无明显差异（调整赔率比 [aOR] 1.15，95% CI 0.68-1.94）。各组的 PH 和死亡率也相似。在症状出现后 4.5 小时内成像的亚组中，这些结果是一致的。荟萃分析支持这些结果，显示桥接 MT 未改善行走能力（aOR 1.16，95% CI 0.82-1.64）或降低 PH。对高质量研究的进一步分析也支持这些结果：队列研究和荟萃分析提供了II级证据，表明桥接式MT和直接MT治疗大面积脑梗死在功能预后或出血风险方面没有显著差异。这表明直接MT可能是桥接MT的可行替代方案。

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To bridge or not to bridge: The role of intravenous thrombolysis in mechanical thrombectomy for large cerebral infarctions through a two-center cohort study and meta-analysis

Background

The effectiveness and safety of intravenous thrombolysis before mechanical thrombectomy (MT) in large cerebral infarctions remains uncertain. This study compares bridging MT, which includes intravenous thrombolysis, to direct MT without it.

Methods

Data from 298 patients with anterior circulation large cerebral infarctions, assessed via non-enhanced CT (ASPECTS 0-5), who underwent MT in two-center cohort studies, were analyzed. Primary outcomes focused on independent ambulation (modified Rankin Scale scores 0-3) at 90 days post-stroke. Safety outcomes included parenchymal hemorrhage (PH) rates and mortality. We conducted a sensitivity analysis considering the timing from symptom onset to imaging within 4.5 hours. Additionally, a meta-analysis of 17 studies involving 3527 patients assessed the interventions' effectiveness and safety, with further scrutiny of high-quality studies (Newcastle-Ottawa Scale ratings 7-9) to increase robustness of results.

Results

No significant differences were found in 90-day independent ambulation between the bridging MT and the direct MT group (adjusted odds ratio [aOR] 1.15, 95% CI 0.68-1.94). Rates of PH and mortality were also similar across groups. These outcomes were consistent in the subgroup imaged within 4.5 hours of symptom onset. The meta-analysis supported these outcomes, showing no improvement in ambulation (aOR 1.16, 95% CI 0.82-1.64) or reduction in PH with bridging MT. Further analysis of high-quality studies supported these results.

Conclusions

The cohort study and meta-analysis provide Class II evidence indicating no significant differences in functional outcomes or hemorrhagic risks between bridging and direct MT for large cerebral infarctions. This suggests that direct MT might be a viable alternative to bridging MT.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.