前循环卒中血管内血栓切除术治疗：随机对照试验的汇总分析

Endovascular mechanical thrombectomy for anterior circulation stroke：a meta-analysis of randomized controlled trials

目的：评价前循环卒中患者血管内血栓切除术治疗的有效性和安全性。方法检索PubMed、EMBASE、Cochrane、Clinical Trials 数据库和相关补充资料,纳入在前循环卒中患者中比较静脉溶栓治疗与血管内血栓切除术治疗的随机临床对照试验,进行偏倚风险评价,提取研究基本特征和90 d时转归良好（定义为改良 Rankin 量表评分0～2分）、死亡以及有症状颅内出血（symptomatic intracranial hemorrhage, sICH）等数据,应用 Review Manager 5．3软件进行统计学分析。结果共纳入10项研究,其中血管内治疗组共1557例患者,静脉溶栓治疗组共1359例患者。纳入研究的质量整体较高,产生偏倚的风险较低。血管内治疗组转归良好率显著高于静脉溶栓对照组[优势比（odds ratio, OR）2．15,95%可信区间（confidence interval, CI）1．34～3．46；P 〈0．01],90 d死亡风险与静脉溶栓治疗组无显性差异（OR 0．86,95% CI 0．69～1．06；P =0．16）,但 sICH 风险增高存在临界性统计学意义（OR 1．35,95% CI 1．00～1．84；P =0．05）。结论前循环卒中患者行血管内血栓切除术治疗的有效性显著优于静脉溶栓治疗,但在安全性方面仍需进一步评价。

Objective To evaluate the efficacy and safety of endovascular mechanical thrombectomy in patients with anterior circulation stroke. Methods PubMed, EMBASE, Cochrane database, Clinical Trials and the related supplement resources were retrieved. The randomized controled trials for comparing intravenous thrombolysis and endovascular mechanical thrombectomy in patients with anterior circulation stroke were selected. The bias risk assessment was performed. The basic characteristics of studies and the clinical outcome data at day 90, including good outcome （defined as the modified Rankin scale score 0-2）, death and symptomatic intracranial hemorrhage （sICH） were extracted. Review Manager 5.3 software was used to conduct the statistical analysis. Results A total of 10 articles were enroled, including 1 557 patients in the endovascular mechanical thrombectomy group and 1 359 in the intravenous thrombolysis group. The overal quality of the included trials was higher. The risk of bias was lower. The good outcome rate in the endovascular mechanical thrombectomy group was significantly higher than that in the intravenous thrombolysis group （odds ratio [ OR] 2. 15, 95% confidence interval [ CI] 1. 34-3. 46; P 〈 0. 01）. The death risk at day 90 was significantly lower than that in the intravenous thrombolysis group （OR 0. 86, 95% CI 0. 69-1. 06; P = 0. 16）, and there was borderline statistical significance for the risk of sICH （OR 1. 35, 95% CI 1. 00- 1. 84; P = 0. 05 ）. Conclusions The effectiveness of the endovascular mechanical thrombectomy is superior to the intravenous thrombolysis in patients with anterior circulation stroke;however, in terms of safety, further evaluation is needed.