桥接溶栓与直接血管内血栓切除术治疗ASPECTS≤5的急性缺血性脑卒中患者：一项荟萃分析。
完整摘要 · 中文译文
背景：血管内血栓切除术（EVT）是治疗由大血管闭塞（LVO）引起的急性缺血性卒中（AIS）的标准方法。然而，与直接EVT（dEVT）相比，桥接溶栓（BT）的有效性和安全性仍存在争议，尤其是在大面积核心梗死（阿尔伯塔卒中项目早期CT评分[ASPECTS]≤5）患者中。本荟萃分析旨在比较BT与dEVT在该人群中的有效性和安全性。 方法：我们系统检索了PubMed、Embase和Web of Science数据库，检索时间范围为2010年1月1日至2024年9月21日，纳入比较BT与dEVT治疗ASPECTS≤5的AIS患者的研究。结局指标包括功能结局（mRS 0-2和0-3）、颅内出血（ICH）、症状性ICH（sICH）、90天死亡率和成功再灌注。数据采用随机效应模型进行合并。 结果：共纳入12项研究（3907例患者）。与dEVT相比，BT显著改善了良好功能结局（OR：1.43，95% CI：1.17-1.76）和中度功能结局（OR：1.28，95% CI：1.10-1.48）。sICH、ICH、90天死亡率或成功再灌注方面未观察到显著差异。 结论：我们的研究结果表明，对于ASPECTS≤5的患者，BT可能与更好的功能结局相关，且与dEVT相比未增加主要安全性事件。然而，这些发现应谨慎解读，因为证据主要来自观察性研究，残余混杂因素不能被排除。需要进一步设计良好的随机对照试验来证实这些发现。
完整摘要 · 英文原文
BACKGROUND: Endovascular thrombectomy (EVT) is a standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, the efficacy and safety of bridging thrombolysis (BT) compared to direct EVT (dEVT) remain controversial, particularly in patients with large core infarcts (Alberta stroke program early CT score [ASPECTS] ≤5). This meta-analysis aimed to compare the efficacy and safety of BT versus dEVT in this population. METHODS: We systematically searched PubMed, Embase, and Web of Science from January 1, 2010, to September 21, 2024, for studies comparing BT and dEVT in AIS patients with ASPECTS ≤5. Outcomes included functional outcomes (mRS 0-2 and 0-3), intracranial hemorrhage (ICH), symptomatic ICH (sICH), 90-day mortality, and successful reperfusion. Data were pooled using random-effects models. RESULTS: Twelve studies (3907 patients) were included. BT significantly improved favorable (OR: 1.43, 95% CI: 1.17-1.76) and moderate functional outcomes (OR: 1.28, 95% CI: 1.10-1.48) compared to dEVT. No significant differences were observed in sICH, ICH, 90-day mortality, or successful reperfusion. CONCLUSIONS: Our findings suggest that BT may be associated with better functional outcomes in patients with ASPECTS ≤5, without increasing major safety events compared with dEVT. However, these findings should be interpreted cautiously because the evidence is mainly observational, and residual confounding cannot be excluded. Further well-designed randomized controlled trials are needed to confirm these findings.