Zhongguo cuzhong zazhi (May 2022)
脑动脉前循环串联病变临床治疗效果meta分析Meta-analysis of Clinical Outcomes of Treatment for Anterior Circulation Tandem Lesions
Abstract
Objective To compare the differences in clinical outcomes of different treatments for anterior circulation tandem lesions. Methods Databases including PubMed, Cochrane Library, ScienceDirect, CNKI, VIP, and Wanfang were retrieved from inception to December 11, 2021 to search for the literatures involving interventional treatment for anterior circulation tandem lesions in patients with acute ischemic stroke. The patients were divided into the intervention group and control group. Treatment strategy in intervention group was simultaneous emergency interventional treatment of both lesions, including thrombectomy or thrombolysis combined with stenting, and treatment strategy in control group was first interventional treatment of the responsible lesion, including thrombectomy or thrombolysis combined with stenting, and then selective treatment of the other lesion. The clinical outcomes including technical recanalization (TICI≥2b) rate, 90-day good prognosis (mRS score of 0-2), and mortality rate were compared between the two groups. The literature quality was evaluated according to Cochrane systematic evaluation principles, and then meta-analysis was performed using R version 4.1.2. When ≥5 studies were included, funnel plots were drawn toidentify publication bias and asymmetry test were performed. Results A total of 6 literatures were included in the final analysis, involving 779 patients with 584 in intervention group and 195 in control group. Meta-analysis results showed that there were statistical differences in technical success rate (OR 2.14, 95%CI 1.68-2.74, P =0.002), 90-day good prognosis rate (OR 1.46, 95%CI 1.20-1.76, P =0.049), and mortality rate (OR 0.60, 95%CI 0.47-0.76, P =0.035) between the intervention and control groups. The funnel plot was symmetrical from left to right, indicating that there was no significant publication bias for the included literatures. Conclusions In patients with anterior circulation tandem lesions, simultaneous emergency interventional treatment of both lesions is prone to higher recanalization rate, better 90-day clinical prognosis and lower mortality rate. 目的 比较脑动脉前循环串联病变所致急性缺血性卒中不同治疗方法的临床预后差异。方法 计算机检索PubMed、Cochrane Library、ScienceDirect、CNKI、VIP、万方数据库从建库至2021年12月11日公开发表的关于脑动脉前循环串联病变的急性缺血性卒中患者介入治疗方式的文献。结局指标采用术后血流再灌注TICI评分≥2b级、90 d预后良好（mRS 0～2分）和死亡率对干预组（两个病灶同时急诊介入治疗，包括取栓/溶栓治疗联合支架治疗）和对照组（先对判定的责任病灶进行介入治疗，包括取栓/溶栓联合支架治疗，另一病灶择期处理）进行评估。根据Cochrane系统评价原则对纳入的研究进行质量评价后采用R version 4.1.2进行多重测量结局的meta分析，效应指标以OR 及95%CI表示。纳入研究≥5项，绘制漏斗图识别发表偏倚及进行不对称检验。结果 最终纳入6篇符合标准的文献，共779例患者，其中干预组584例，对照组195例。多重测量结局的meta分析结果显示，干预组与对照组TICI≥2b级（OR 2.14，95%CI 1.68～2.741，P =0.002）、90 d良好预后率（OR 1.46，95%CI 1.20～1.76，P =0.049）、死亡率（OR 0.60，95%CI 0.47～0.761，P =0.035）的差异均有统计学意义。漏斗图左右对称，表明本研究纳入的文献发表偏倚不明显。结论 在脑动脉前循环串联病变患者中，两个病灶同时进行急诊介入治疗血流再灌注更好，90 d临床预后更优，死亡率更低。脑动脉前循环病变的介入治疗是临床急性缺血性卒中再灌注治疗的难点和争议点，本研究通过meta分析对目前发表的相关文章进行了综合，结果显示对串联病变同时进行急诊介入治疗的再灌注效果和90 d预后要优于急诊仅处理单个病变。
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