Endovascular Thrombectomy for Large Ischemic Strokes: A Living Systematic Review and Meta-Analysis of Randomized Trials

被引:17
|
作者
Morsi, Rami Z. [1 ]
Elfil, Mohamed [2 ]
Ghaith, Hazem S. [3 ]
Aladawi, Mohammad [2 ]
Elmashad, Ahmad [4 ]
Kothari, Sachin [1 ]
Desai, Harsh [1 ]
Prabhakaran, Shyam [1 ]
Al-Mufti, Fawaz [5 ,7 ]
Kass-Hout, Tareq [1 ,6 ]
机构
[1] Univ Chicago, Dept Neurol, Chicago, IL USA
[2] Univ Nebraska Med Ctr, Dept Neurol Sci, Omaha, NE USA
[3] Al Azhar Univ, Fac Med, Cairo, Egypt
[4] Univ Connecticut, Dept Neurol, Farmington, CT USA
[5] Westchester Med Ctr, Dept Neurosurg, Valhalla, NY USA
[6] Univ Chicago, Dept Neurol, 5941 S Maryland Ave,MC 2030, Chicago, IL 60637 USA
[7] Westchester Med Ctr, Dept Neurol Neurosurg & Radiol, 100 Woods Rd,4th floor, Valhalla, NY 10595 USA
关键词
Thrombectomy; Large infarct; Low ASPECTS; Systematic review; GRADE; THERAPY;
D O I
10.5853/jos.2023.00752
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only.Methods We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of -bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low -certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD-0.7%, 95% CI-3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI-0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only.Conclusion Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.
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收藏
页码:214 / +
页数:14
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