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Efficacy and safety of endovascular treatment for patients with acute intracranial atherosclerosis-related posterior circulation stroke: a systematic review and meta-analysis.
Reviews in the Neurosciences ( IF 4.1 ) Pub Date : 2020-09-15 , DOI: 10.1515/revneuro-2020-0025 Jiajia Bao 1 , Ye Hong 1 , Chaohua Cui 1 , Mengmeng Ma 1 , Lijie Gao 1 , Qian Liu 1 , Ning Chen 1 , Li He 1
Reviews in the Neurosciences ( IF 4.1 ) Pub Date : 2020-09-15 , DOI: 10.1515/revneuro-2020-0025 Jiajia Bao 1 , Ye Hong 1 , Chaohua Cui 1 , Mengmeng Ma 1 , Lijie Gao 1 , Qian Liu 1 , Ning Chen 1 , Li He 1
Affiliation
The benefit of endovascular treatment (EVT) for patients with intracranial atherosclerosis–related large vessel occlusion (ICAS-LVO) in posterior circulation stroke (PCS) is inconsistent. This systematic review and meta-analysis were conducted to estimate the effect of ICAS-LVO in PCS treated by EVT. A systematic review was completed, tracking studies from their date of inception until February 2020. Clinical studies which compared outcomes after EVT for ICAS-LVO and non–ICAS-LVO in PCS were included. Data were synthesized and interpreted from meta-analysis. A total of 688 patients (352 ICAS-LVO and 336 non–ICAS-LVO) in the eight studies were included. The successful reperfusion rate (odds ratio [OR], 0.58; 95% confidence intervals [95% CIs], 0.37–0.93; P = 0.02) was lower in PCS with ICAS-LVO than non–ICAS-LVO. And for other clinical outcomes, there were no differences between both groups. Moreover, there were no statistical differences of any clinical outcome among subgroups stratified by nations and target vessel occlusion location. With respect to patients’ characteristics, age (mean difference [MD], −2.75; 95% CI, −4.62–−0.88; P = 0.004), pc-Alberta Stroke Program Early CT Score (MD, −0.49; 95% CI, −0.94–−0.05; P = 0.03), distributions of sex (male) (OR, 2.34; 95% CI, 1.53–3.56; P < 0.001), prior or current smoking (OR, 1.85; 95% CI, 1.12–3.07; P = 0.02), hypertension (OR, 2.06; 95% CI, 1.32–3.22; P = 0.002), coronary artery disease (OR, 0.27; 95% CI, 0.11–0.66; P = 0.004) and general anesthesia (OR, 2.89; 95% CI, 1.54–5.45; P = 0.001) were statistically different between both groups. In conclusion, more targeted assessments are warranted for patients with ICAS-LVO–related PCS during clinical strategies, and the benefit of EVT for PCS with ICAS-LVO deserves further research.
中文翻译:
急性颅内动脉粥样硬化相关性后循环卒中患者血管内治疗的有效性和安全性:系统评价和荟萃分析。
对于后循环卒中(PCS)伴有颅内动脉粥样硬化相关大血管闭塞(ICAS-LVO)的患者,进行血管内治疗(EVT)的益处不一致。进行了系统的回顾和荟萃分析,以评估ICAS-LVO在EVT治疗的PCS中的作用。已完成系统的综述,从研究开始至2020年2月追踪研究。纳入了比较PCS中ICAS-LVO和非–ICAS-LVO EVT后结果的临床研究。通过荟萃分析对数据进行合成和解释。八项研究共纳入688名患者(352 ICAS-LVO和336非ICAS-LVO)。成功的再灌注率(优势比[OR]为0.58; 95%置信区间[95%CIs]为0.37-0.93;P= 0.02)在使用ICAS-LVO的PCS中要比未使用-ICAS-LVO的PCS低。对于其他临床结果,两组之间没有差异。而且,在按国家和目标血管闭塞位置分层的亚组之间,任何临床结局均无统计学差异。关于患者的特征,年龄(平均差异[MD],-2.75; 95%CI,-4.62--0.88;P = 0.004),pc-Alberta中风计划早期CT评分(MD,-0.49; 95%CI ,-0.94--0.05;P = 0.03),性别分布(男性)(OR,2.34; 95%CI,1.53-3.56;P <0.001),既往或目前吸烟(OR,1.85; 95%CI,1.12) –3.07;P = 0.02),高血压(OR为2.06; 95%CI为1.32–3.22;P = 0.002),两组之间的冠状动脉疾病(OR,0.27; 95%CI,0.11-0.66; P = 0.004)和全身麻醉(OR,2.89; 95%CI,1.54-5.45; P = 0.001)在统计学上差异。总之,在临床策略期间,对于ICAS-LVO相关的PCS患者,需要进行更有针对性的评估,而EVT对ICAS-LVO的PCS患者的益处值得进一步研究。
更新日期:2020-09-15
中文翻译:
急性颅内动脉粥样硬化相关性后循环卒中患者血管内治疗的有效性和安全性:系统评价和荟萃分析。
对于后循环卒中(PCS)伴有颅内动脉粥样硬化相关大血管闭塞(ICAS-LVO)的患者,进行血管内治疗(EVT)的益处不一致。进行了系统的回顾和荟萃分析,以评估ICAS-LVO在EVT治疗的PCS中的作用。已完成系统的综述,从研究开始至2020年2月追踪研究。纳入了比较PCS中ICAS-LVO和非–ICAS-LVO EVT后结果的临床研究。通过荟萃分析对数据进行合成和解释。八项研究共纳入688名患者(352 ICAS-LVO和336非ICAS-LVO)。成功的再灌注率(优势比[OR]为0.58; 95%置信区间[95%CIs]为0.37-0.93;P= 0.02)在使用ICAS-LVO的PCS中要比未使用-ICAS-LVO的PCS低。对于其他临床结果,两组之间没有差异。而且,在按国家和目标血管闭塞位置分层的亚组之间,任何临床结局均无统计学差异。关于患者的特征,年龄(平均差异[MD],-2.75; 95%CI,-4.62--0.88;P = 0.004),pc-Alberta中风计划早期CT评分(MD,-0.49; 95%CI ,-0.94--0.05;P = 0.03),性别分布(男性)(OR,2.34; 95%CI,1.53-3.56;P <0.001),既往或目前吸烟(OR,1.85; 95%CI,1.12) –3.07;P = 0.02),高血压(OR为2.06; 95%CI为1.32–3.22;P = 0.002),两组之间的冠状动脉疾病(OR,0.27; 95%CI,0.11-0.66; P = 0.004)和全身麻醉(OR,2.89; 95%CI,1.54-5.45; P = 0.001)在统计学上差异。总之,在临床策略期间,对于ICAS-LVO相关的PCS患者,需要进行更有针对性的评估,而EVT对ICAS-LVO的PCS患者的益处值得进一步研究。