Lue Chen, Qiqi Huo, Qi Wei, Thanh N Nguyen, Mohamad K Abdalkader, Shunfu Jiang, Min Luo, Yu Jing, Lanlan Yang, Shuang Wang, Huiping Jiang, Shiyu Wen, Minyue Sun, Wei Huang, Shaotong Chen, Jian Yi, Guangxiong Yuan, Hongfei Sang, QingWu Yang, Nongyan Wang, Zhongming Qiu, Duolao Wang, Bruce C V Campbell, Yufeng Tang
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引用次数: 0
摘要
背景与目的：机械取栓（MT）后动脉溶栓（IAT）可改善缺血性脑卒中患者微血管再灌注，减少残疾。我们对随机对照试验（RCTs）和观察性队列研究进行了系统回顾和荟萃分析，以探讨MT联合IAT治疗急性缺血性卒中的疗效和安全性。方法：检索Pubmed、Embase、Cochrane Library和Web of Science数据库，检索词为“stroke”、“thrombectomy”、“intra-动脉溶栓”，检索时间为2025年5月30日。主要疗效指标为90天的良好功能预后（改良Rankin评分0-1），关键安全性指标为死亡和症状性脑出血。效应大小用随机效应或固定效应模型的风险比（RR）计算。结果：7项随机对照试验和9项队列研究，共6258例患者符合纳入标准。随机对照试验结果显示，大血管闭塞性卒中患者在接受MT治疗并成功再通后，随后给予IAT显著增加了良好功能结局的机会(mRS 0-1, RR: 1.24, 95% CI 1.12-1.37， p结论：本系统评价和荟萃分析表明，在急性卒中中，MT联合IAT比单独MT有更高的机会获得良好功能结局（mRS 0-1）。重要的是，添加IAT是安全的，不会增加症状性颅内出血和死亡的风险。
The Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis.
Introduction: Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke.
Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms "stroke", "thrombectomy", "intra-arterial thrombolysis". The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0-1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models.
Results: Seven RCTs and 9 cohort studies with a total of 6,258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0-1, RR: 1.24, 95% CI: 1.12-1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04-1.32).
Conclusion: This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0-1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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