脑动脉前循环串联病变临床治疗效果meta分析

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。 

Meta-analysis of Clinical Outcomes of Treatment for Anterior Circulation Tandem Lesions

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 to identify 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.