Scholarlink

Background <p>Distal medium vessel occlusions (DMVO) in stroke patients represent a&#xa0;complex clinical challenge, primarily due to lack of conclusive evidence supporting the superiority of mechanical thrombectomy (MT) over best medical therapy (BMT). This meta-analysis aims to compare clinical outcomes between these two treatment strategies, focusing on functional outcomes assessed by means of modified Rankin Scale (mRS), overall mortality, early neurological improvement (ENI), and incidence of symptomatic intracranial hemorrhage (sICH) or subarachnoid hemorrhage (SAH).</p> Material and Methods <p>Three investigators independently researched all main medical search engines (Medline, Scopus and Cochrane Library) to identify original papers comparing MT and BMT in patients with ischemic stroke due to primary DMVO. Primary endpoint was functional independence at 90&#xa0;days (mRS 0–2), while secondary outcomes included excellent clinical outcome at 90&#xa0;days (mRS 0–1), all-cause mortality, ENI, sICH and SAH.</p> Results <p>A&#xa0;total of 28&#xa0;studies (3&#xa0;randomized control trials and 25&#xa0;retrospective observational studies) comparing MT to BMT, involving 7512 patients were included. Our findings indicate no statistically significant differences in clinical outcomes, both for functional independence (OR:&#xa0;1.05, 95% CI: 0.91–1.21) and excellent outcome (OR:&#xa0;1.07, 95% CI: 0.92–1.24). No statistically significant differences were observed for overall mortality (OR:&#xa0;1.01, 95% CI: 0.80–1.27), ENI (OR:&#xa0;1.30, 95% CI: 0.67–2.51) and rate of sICH (OR:&#xa0;0.93, 95% CI: 0.55–1.58). Statistically significant results were seen on SAH rate which was higher in the MT group (OR:&#xa0;0.01, 95% CI: 0.00–0.11).</p> Conclusions <p>Our meta-analysis did not support the routine use of MT in the treatment of DMVO. Rather, it indicates that MT + BMT does not lead to an increased proportion of patients achieving functional independence or excellent outcome at 3&#xa0;months, nor does it reduce mortality rates compared to BMT alone.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Mechanical Thrombectomy Versus Best Medical Treatment for Patients with Acute Ischemic Stroke and Primary Distal Medium Vessel Occlusion: a Systemic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年12月10日

查看全文
  • Giancarlo Salsano,
  • Bruno Del Sette,
  • Marco Bruzzone,
  • Nicola Mavilio,
  • Davide Sassos,
  • Alessandra Murialdo,
  • Luca Scarcia,
  • Andrea M. Alexandre,
  • Massimo Del Sette,
  • Lucio Castellan

摘要

Background

Distal medium vessel occlusions (DMVO) in stroke patients represent a complex clinical challenge, primarily due to lack of conclusive evidence supporting the superiority of mechanical thrombectomy (MT) over best medical therapy (BMT). This meta-analysis aims to compare clinical outcomes between these two treatment strategies, focusing on functional outcomes assessed by means of modified Rankin Scale (mRS), overall mortality, early neurological improvement (ENI), and incidence of symptomatic intracranial hemorrhage (sICH) or subarachnoid hemorrhage (SAH).

Material and Methods

Three investigators independently researched all main medical search engines (Medline, Scopus and Cochrane Library) to identify original papers comparing MT and BMT in patients with ischemic stroke due to primary DMVO. Primary endpoint was functional independence at 90 days (mRS 0–2), while secondary outcomes included excellent clinical outcome at 90 days (mRS 0–1), all-cause mortality, ENI, sICH and SAH.

Results

A total of 28 studies (3 randomized control trials and 25 retrospective observational studies) comparing MT to BMT, involving 7512 patients were included. Our findings indicate no statistically significant differences in clinical outcomes, both for functional independence (OR: 1.05, 95% CI: 0.91–1.21) and excellent outcome (OR: 1.07, 95% CI: 0.92–1.24). No statistically significant differences were observed for overall mortality (OR: 1.01, 95% CI: 0.80–1.27), ENI (OR: 1.30, 95% CI: 0.67–2.51) and rate of sICH (OR: 0.93, 95% CI: 0.55–1.58). Statistically significant results were seen on SAH rate which was higher in the MT group (OR: 0.01, 95% CI: 0.00–0.11).

Conclusions

Our meta-analysis did not support the routine use of MT in the treatment of DMVO. Rather, it indicates that MT + BMT does not lead to an increased proportion of patients achieving functional independence or excellent outcome at 3 months, nor does it reduce mortality rates compared to BMT alone.