Mechanical thrombectomy for acute ischemic stroke: systematic review and meta-analysis

ABSTRACT Objective To evaluate the safety and efficacy of mechanical thrombectomy associated with standard medical treatment compared with standard medical treatment only to treat patients with acute ischemic stroke. Methods This was a systematic review and metaanalysis of randomized controlled trials. An electronic search was performed in the following databases: MEDLINE ® /PubMed ® , Cochrane Library (Trials), LILACS/IBECS (via Biblioteca Virtual em Saúde (BVS)) and Embase. Complementary searches were also conducted. The selection of studies and data collection were done by two investigators independently. Results The final analysis included 16 publications related to 15 studies. The mechanical thrombectomy was associated to a reduction in the risk of death of all cause (16.81% versus 20.13%; relative risk of 0.85; p=0.04), improvement in the number of patients with functional independence after 90 days (45.65% versus 27.45%; relative risk of 1.65; p<0.01), and improvement in the rate of revascularization (76.2% versus 33.85%; relative risk of 2.20; p<0.01). There was no significant difference in terms of symptomatic intracranial hemorrhage (4.78% versus 3.88%; relative risk of 1.27; p=0.21). Conclusion Mechanical thrombectomy associated with standard medical treatment seem to be safe and effective to treat patients with acute ischemic stroke compared with standard medical treatment only.

摘要 目的 对比机械取栓联合标准药物治疗与单纯标准药物治疗对急性缺血性脑卒中患者的安全性与有效性。方法 本研究为针对随机对照试验的系统综述与荟萃分析。通过MEDLINE®/PubMed®、Cochrane图书馆（试验库）、LILACS/IBECS（通过巴西虚拟健康图书馆（BVS））以及Embase数据库开展电子检索，并辅以补充检索。由2名研究者独立完成文献筛选与数据采集工作。结果 最终分析纳入15项研究相关的16篇文献。结果表明，机械取栓组患者全因死亡风险显著降低（16.81% vs 20.13%；相对风险=0.85，P=0.04）；90天后功能独立患者占比明显提升（45.65% vs 27.45%；相对风险=1.65，P<0.01）；血管再通率显著改善（76.2% vs 33.85%；相对风险=2.20，P<0.01）。两组症状性颅内出血发生率无显著统计学差异（4.78% vs 3.88%；相对风险=1.27，P=0.21）。结论 与单纯标准药物治疗相比，机械取栓联合标准药物治疗用于急性缺血性脑卒中患者，展现出更优的安全性与有效性。