抽吸取栓与支架取栓治疗急性缺血性卒中有效性及安全性的meta分析

doi:10.3969/j.issn.1673-5765.2025.08.008

摘要/Abstract

摘要： 目的探讨抽吸取栓与支架取栓治疗急性缺血性卒中（acute ischemic stroke，AIS）的有效性及安全性。
方法检索PubMed、Cochrane Library、Embase、中国知网、万方、维普等中英文数据库，筛选比较抽吸取栓与支架取栓治疗AIS效果的研究。有效性指标包括90 d mRS评分、血管再通成功和穿刺至血管再通时间；安全性指标包括出血转化、90 d全因死亡和其他并发症（血管穿孔及夹层、血管痉挛、新发栓塞）。采用漏斗图对纳入研究进行偏倚风险评估。使用RevMan 5.3软件进行meta分析。
结果共纳入35项研究，包括4865例患者。在有效性方面，抽吸取栓组的90 d mRS评分优于支架取栓组（OR 1.44，95%CI 1.03～2.00，P＝0.030），血管再通成功率高于支架取栓组（OR 1.50，95%CI 1.18～1.92，P＜0.001），穿刺至血管再通时间短于支架取栓组[标准化均数差（standardized mean difference，SMD）－6.57，95%CI －7.80～－5.34，P＜0.001]。在安全性方面，两种术式的出血转化率（OR 0.92，95%CI 0.76～1.12，P＝0.410）、90 d全因死亡率（OR 0.86，95%CI 0.64～1.16，P＝0.310）和其他并发症发生率（OR 0.91，95%CI 0.75～1.09，P＝0.330）的差异均无统计学意义。
结论与支架取栓相比，抽吸取栓治疗AIS的安全性相似，但在血管再通成功率及短期预后方面具有一定的优势，且穿刺至血管再通时间较短。

文章导读： 针对35项研究的meta分析提示，基于目前研究证据，抽吸取栓相较于支架取栓，可改善AIS患者的短期预后，缩短血管再通时间，两种治疗方式的安全性相似。

关键词: 急性缺血性卒中; 抽吸取栓; 支架取栓; meta分析

Abstract: Objective To explore the efficacy and safety of aspiration thrombectomy and stent retriever thrombectomy in the treatment of acute ischemic stroke (AIS).
Methods Chinese and English databases, including PubMed, Cochrane Library, Embase, CNKI, Wanfang, and VIP, were searched to screen studies comparing the efficacy of aspiration thrombectomy and stent retriever thrombectomy in AIS. The efficacy indicators included 90-day mRS score, successful recanalization, and puncture-to-recanalization time. The safety indicators included hemorrhagic transformation, 90-day all-cause mortality, and other complications (vascular perforation/dissection, vasospasm, and new-onset embolism). The funnel plot was used to assess the risk of bias among the included studies. Meta-analysis was performed using RevMan 5.3 software.
Results A total of 35 studies involving 4865 patients were included. In terms of efficacy, the aspiration thrombectomy group demonstrated superior 90-day mRS scores than the stent retriever thrombectomy group (OR 1.44, 95%CI 1.03-2.00, P=0.030), higher successful recanalization rates than the stent retriever thrombectomy group (OR 1.50, 95%CI 1.18-1.92, P<0.001), and shorter puncture-to-recanalization time than the stent retriever thrombectomy group [standardized mean difference (SMD) -6.57, 95%CI -7.80--5.34, P<0.001]. In terms of safety, there were no statistically significant differences between the two techniques in hemorrhagic transformation rate (OR 0.92, 95%CI 0.76-1.12, P=0.410), 90-day all-cause mortality (OR 0.86, 95%CI 0.64-1.16, P=0.310), and the rates of other complications (OR 0.91, 95%CI 0.75-1.09, P=0.330).
Conclusions Compared with stent retriever thrombectomy, aspiration thrombectomy has similar safety for treating AIS, but has certain advantages in the successful recanalization rate and short-term prognosis, with a shorter puncture-to-recanalization time.

Key words: Acute ischemic stroke; Aspiration thrombectomy; Stent retriever thrombectomy; Meta-analysis

中图分类号:

刘安利, 薛茜, 杨金水, 苗瑞瑞, 王欢欢. 抽吸取栓与支架取栓治疗急性缺血性卒中有效性及安全性的meta分析[J]. 中国卒中杂志, 2025, 20(8): 992-1005.

LIU Anli, XUE Qian, YANG Jinshui, MIAO Ruirui, WANG Huanhuan. Meta-Analysis of the Efficacy and Safety of Aspiration Thrombectomy and Stent Retriever Thrombectomy in the Treatment of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(8): 992-1005.

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