Objective

We compared outcomes and adverse events of thrombectomy versus medical management in acute ischemic stroke (AIS) patients with baseline large infarct core.

Methods

We searched Ovid MEDLINE(R) ALL, Cochrane Library Clinical Controlled Trials and EMBASE from inception to January 2021 for studies comparing thrombectomy and medical management alone in AIS patients who had ASPECTS <=7 or ischemic core volume >=50 ml. Imaging modalities to valuate ASPECTS and core volume were without restriction. The functional outcome was measured by mRS (modified Rankin Scale) score 0-2 at 90 days or discharge. The safety end point included the rates of mortality and sICH (symptomatic intracranial hemorrhage) or PH2 (parenchymal hematoma type 2).

Results

Fourteen studies with a total of 2547 patients (thrombectomy n = [1197]; medical care alone [n = 1350]) fulfilled our criteria. As for patients with low ASPECTS, pooled results indicated a higher odds of good functional outcome (OR = 3.47; 95% CI 1.99 to 6.07; P < 0.0001, I²=66%) and a lower risk of mortality (OR = 0.62; 95% CI 0.46 to 0.83; P = 0.001, I²=32%) in thrombectomy group compared with no thrombectomy group, but the risk of sICH or PH2 did not differ between two groups. As for patients with large core volume, both functional outcome and safety end point between two groups showed no statistically significant difference.

Conclusion

Thrombectomy remained safe and effective by careful selection in patients with low ASPECTS. More studies were warranted to explore contraindications for mechanical thrombectomy in AIS patients, especially in patients with large core volume.

中文翻译：

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大缺血核心的机械取栓与单独医疗护理：最新的荟萃分析

客观的

我们比较了具有基线大梗死核心的急性缺血性卒中 (AIS) 患者血栓切除术与药物治疗的结局和不良事件。

方法

我们检索了 Ovid MEDLINE(R) ALL、Cochrane Library 临床对照试验和 EMBASE 从开始到 2021 年 1 月的研究，以比较 ASPECTS <=7 或缺血性核心体积 >=50 ml 的 AIS 患者的血栓切除术和单独药物管理的研究。评估 ASPECTS 和核心体积的成像方式不受限制。功能结果通过 90 天或出院时的 mRS（改良 Rankin 量表）评分 0-2 来衡量。安全终点包括死亡率和 sICH（症状性颅内出血）或 PH2（2 型实质血肿）的发生率。

结果

共有 2547 名患者的 14 项研究（血栓切除术 n = [1197]；仅医疗护理 [n = 1350]）符合我们的标准。对于 ASPECTS 低的患者，汇总结果表明获得良好功能结果的几率更高（OR = 3.47；95% CI 1.99 至 6.07；P < 0.0001，I ² =66%）和较低的死亡风险（OR = 0.62； 95% CI 0.46 至 0.83；P = 0.001，I ² =32%) 取栓组与未取栓组相比，但两组之间 sICH 或 PH2 的风险没有差异。对于大核心体积的患者，两组之间的功能结果和安全终点均无统计学差异。

结论

通过仔细选择低 ASPECTS 的患者，血栓切除术仍然是安全和有效的。需要更多的研究来探索 AIS 患者机械血栓切除术的禁忌症，尤其是在大核心体积的患者中。