Background

The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for patients with M2 occlusion. This study aims to compare the efficacy and safety of endovascular treatment (EVT) with best medical management (BMM) in patients with M2 occlusion, and to investigate whether the optimal treatment varies according to stroke severity.

Methods

Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT and BMM. According to stroke severity, the study population were classified into those with moderate-severe stroke and those with mild stroke. National Institute of Health Stroke Scale (NIHSS) scores ≥ 6 was defined as moderate-severe stroke, and NIHSS scores 0–5 as mild stroke. Random-effects meta-analyses were performed to measure the symptomatic intracranial hemorrhage (sICH) within 72 h, and the modified Rankin Scale (mRS) scores 0–2 and the mortality at 90 days.

Results

Totally, 20 studies were identified, including 4358 patients. In the moderate-severe stroke population, the EVT had 82% higher odds for mRS scores 0–2 (OR 1.82, 95% CI 1.34–2.49) and a 43% lower odds for mortality (OR 0.57, 95% CI 0.39–0.82) compared with the BMM. However, no difference was found in the sICH rate (OR 0.88, 95% CI 0.44–1.77). In the mild stroke population, no differences were observed in the mRS scores 0–2 (OR 0.81, 95% CI 0.59–1.10) or mortality (OR 1.23, 95% CI 0.72–2.10) between EVT and BMM, whereas EVT was associated with higher sICH rate (OR 4.21, 95% CI 1.86–9.49).

Conclusion

EVT may be only beneficial for patients with M2 occlusion and high stroke severity, but not for those with NIHSS scores 0–5.

中文翻译：

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对于 M2 闭塞和高卒中严重程度的患者，血管内治疗比最佳药物治疗取得更好的结果：一项荟萃分析

背景

由于缺乏随机证据，很难为 M2 闭塞患者建立可靠的治疗建议。本研究旨在比较血管内治疗 (EVT) 与最佳医疗管理 (BMM) 治疗 M2 闭塞患者的疗效和安全性，并探讨最佳治疗是否因卒中严重程度而异。

方法

进行了全面的文献检索，以确定直接比较 EVT 和 BMM 结果的研究。根据中风的严重程度，研究人群被分为中重度中风和轻度中风。美国国立卫生研究院卒中量表 (NIHSS) 评分≥ 6 定义为中重度卒中，NIHSS 评分 0-5 定义为轻度卒中。进行随机效应荟萃分析以测量 72 小时内的症状性颅内出血 (sICH)、改良 Rankin 量表 (mRS) 评分 0–2 和 90 天时的死亡率。

结果

总共确定了 20 项研究，包括 4358 名患者。在中重度卒中人群中，EVT 的 mRS 评分 0-2 的几率高 82%（OR 1.82，95% CI 1.34-2.49），死亡率低 43%（OR 0.57，95% CI 0.39-0.82） ) 与 BMM 相比。然而，sICH 发生率没有差异（OR 0.88，95% CI 0.44–1.77）。在轻度卒中人群中，EVT 和 BMM 之间的 mRS 评分 0-2（OR 0.81，95% CI 0.59-1.10）或死亡率（OR 1.23，95% CI 0.72-2.10）没有观察到差异，而 EVT 与具有更高的 sICH 率（OR 4.21，95% CI 1.86–9.49）。

结论

EVT 可能仅对 M2 闭塞和卒中严重程度高的患者有益，但对 NIHSS 评分为 0-5 的患者无效。