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Do thrombolysis outcomes differ between anterior circulation stroke and posterior circulation stroke? A systematic review and meta-analysis.
International Journal of Stroke ( IF 6.7 ) Pub Date : 2020-03-02 , DOI: 10.1177/1747493020909634
Sang-Hun Lee 1 , Jung Hoon Han 2 , Ileok Jung 1 , Jin-Man Jung 1
Affiliation  

BACKGROUND It remains unclear whether thrombolysis outcomes can be influenced by the affected vascular territory (i.e. anterior circulation stroke vs. posterior circulation stroke) in stroke patients owing to the lack of randomized controlled trials. AIMS Using multiple comprehensive databases, we searched for observational studies of the safety and efficacy of intravenous thrombolytics and intra-arterial treatment with or without intravenous thrombolytics in accordance with the affected vascular territory. We performed a systematic review and meta-analysis. We evaluated symptomatic intracerebral hemorrhage, all-type intracerebral hemorrhage, mortality, and functional outcomes at three months. The recanalization rate was assessed in the intra-arterial treatment group. SUMMARY OF REVIEW Twenty-one studies including a report from our own stroke registry were included through quantitative synthesis. Compared with the anterior circulation stroke group, the posterior circulation stroke group had a lower risk of ICH, including symptomatic intracerebral hemorrhage and all-type intracerebral hemorrhage, after intravenous thrombolytics and tended to have favorable functional outcomes at three months. Mortality was similar between the two groups. Regarding intra-arterial treatment, the symptomatic intracerebral hemorrhage and post-procedural recanalization rates were comparable between the two groups, although the posterior circulation stroke group had a higher mortality risk and lower tendency for a favorable functional outcome. CONCLUSIONS Safety and efficacy of thrombolysis in posterior circulation stroke depends on involvement of large vessel occlusion and reperfusion modality such that intravenous thrombolytics is more effective and safer than in anterior circulation stroke; the safety and efficacy of intra-arterial treatment is comparable or lower than anterior circulation stroke. Considering the limitations of our meta-analysis, further studies are needed to provide high level evidence of a beneficial effect of intra-arterial treatment, and to identify patients' profiles associated with benefit of treatment.

中文翻译:

前循环卒中和后循环卒中的溶栓结果是否不同?系统评价和荟萃分析。

背景 由于缺乏随机对照试验,目前尚不清楚溶栓结果是否会受到卒中患者受影响的血管区域(即前循环卒中与后循环卒中)的影响。目的 使用多个综合数据库,我们根据受影响的血管区域搜索了静脉溶栓剂和动脉内治疗有或没有静脉溶栓剂的安全性和有效性的观察性研究。我们进行了系统回顾和荟萃分析。我们评估了三个月的症状性脑出血、所有类型的脑出血、死亡率和功能结果。在动脉内治疗组中评估再通率。综述总结 通过定量综合纳入了 21 项研究,其中包括一份来自我们自己的卒中登记处的报告。与前循环卒中组相比,后循环卒中组在静脉溶栓后发生 ICH 的风险较低,包括症状性脑出血和全类型脑出血,并且在 3 个月时具有良好的功能预后。两组之间的死亡率相似。在动脉内治疗方面,尽管后循环卒中组的死亡风险较高且功能结果良好的趋势较低,但两组的症状性脑出血和术后再通率相当。结论 后循环卒中溶栓的安全性和有效性取决于大血管闭塞和再灌注方式的参与,因此静脉溶栓比前循环卒中更有效、更安全;动脉内治疗的安全性和有效性与前循环卒中相当或更低。考虑到我们的荟萃分析的局限性,需要进一步研究以提供动脉内治疗有益效果的高水平证据,并确定与治疗益处相关的患者概况。动脉内治疗的安全性和有效性与前循环卒中相当或更低。考虑到我们的荟萃分析的局限性,需要进一步研究以提供动脉内治疗有益效果的高水平证据,并确定与治疗益处相关的患者概况。动脉内治疗的安全性和有效性与前循环卒中相当或更低。考虑到我们的荟萃分析的局限性,需要进一步研究以提供动脉内治疗有益效果的高水平证据,并确定与治疗益处相关的患者概况。
更新日期:2020-04-20
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