Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

摘要

Neurothrombectomy is being used increasingly for the treatment of acute ischemic stroke. To assess the recanalization rates and clinical outcomes of patients treated with neurothrombectomy, we searched the CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedical Literature), MEDLINE and EMBASE databases to 2011 and summarized the outcome data of patients with acute ischemic stroke treated with neurothrombectomy. Forty-six studies (1530 patients) that reported recanalization rates were included in this analysis. Recanalization rates were recorded for the following neurothrombectomy techniques: endovascular thrombectomy (43-100%, median 86%), endovascular thromboaspiration (67-100%, median 83%), laser thrombolysis (41-50%, median 45.5%), and ultrasonification (62-71%, median 66.5%); the respective rates of symptomatic and asymptomatic intracranial hemorrhage were 20%, 22.5%, 12%, and 19% for each of the four types of neurothrombectomy. Clinical outcome data categorized by success or failure in achieving recanalization were available from 12 articles pertaining to 443 patients. At three months, patients in whom recanalization was achieved had better functional outcomes compared to non-recanalized patients (odds ratio [OR], 5.58; 95% confidence interval [CI], 2.98-10.45). In addition, the three-month mortality was lower in recanalized patients (OR, 0.37; 95% CI, 0.24-0.57). Among the various treatments for acute ischemic stroke, neurothrombectomy appears the most promising. Neurothrombectomy devices show great potential in improving functional outcomes and reducing mortality in patients with acute ischemic stroke, and meta-analysis confirms that successful recanalization was the most important indicator of predicting clinical benefit.