Wingspan支架治疗颅内动脉粥样硬化性狭窄单组率的Meta分析  

Intracranial Angioplasty with Gateway-Wingspan System for Atherosclerotic Stenosis:A Meta-analysis of Single rate

作　　者：尹榕[1] 刘曌[1] 张国桢[1] 陈丽萍[1] 曹丽[1] 石向群[1] 洪波[2] 刘建民[2] 

机构地区：[1]兰州军区兰州总医院神经内科,兰州730050 [2]第二军医大学长海医院神经外科,上海200433

出　　处：《中国循证医学杂志》2015年第3期295-304,共10页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金(编号:30973102);全军医药卫生科研基金(编号:CLZ12JB02);甘肃省青年科技基金计划(编号:1208RJYA088)

摘　　要：目的系统评价Wingspan支架治疗颅内动脉粥样硬化性狭窄疾病的疗效及安全性,为临床实践与研究提供参考。方法计算机检索Pub Med、The Cochrane Library(2014年第1期)、EMbase、CENTRAL、CBM、CNKI、VIP和中国硕博士论文数据库,收集所有Wingspan支架治疗颅内动脉粥样硬化性狭窄的随机对照试验(RCT)、非随机对照研究、病例-对照研究、队列研究、病例系列报告等,检索时限均从2005年1月1日至2014年1月10日。由2名评价员按照纳入与排除标准筛选文献和提取资料后,采用R软件进行Meta分析。结果最终纳入34篇文献,包括2 511例患者。其中RCT 2篇,队列研究22篇,病例-对照研究10篇。单组率的Meta分析结果显示:手术总体成功率为96.75%[95%CI(95.82%,97.48%)],30天终点事件发生率为8.75%[95%CI(7.61%,10.04%)],1年终点事件发生率为13.00%[95%CI(11.47%,14.70%)],总病死率为2.98%[95%CI(2.16%,4.10%)],支架内再狭窄发生率为21.76%[95%CI(18.27%,25.71%)],症状性再狭窄占总观察例数的比率为6.50%[95%CI(4.89%,8.60%)],症状性再狭窄占发生再狭窄例数的比率为26.06%[95%CI(19.94%,33.29%)]。结论当前证据显示,Wingspan支架治疗颅内动脉粥样硬化性狭窄疾病是有效、安全的。上述结论尚需进一步开展对照研究,尤其是RCT来进一步验证。Objective To systematically review the safety and validity of the treatment of intracranial atherosclerosis diseases（ICAD） by using Wingspan stents,and to provide the reference for clinical practice and research. Methods Databases such as the Pub Med,The Cochrane Library,EMbase,Cochrane Central Register of Controlled Trials,CBM,CNKI and VIP were searched for studies concerning the safety and validity of the treatment of intracranial atherosclerosis diseases（ICAD） by using Wingspan stents from January 1st,2005 to January 10 th,2014. Randomized controlled trials（RCTs）,non-randomized controlled trials,case-control studies,cohort studies and case series were all included. Two reviewers independently screened literature according to inclusion and exclusion criteria,extracted data. Then,meta-analysis was performed by using the R software. Results A total of 34 studies（2 RCTs,22 cohort studies,and 10 case-control studies） involving 2 511 patients were included. The results of meta-analysis showed that： operation success rates was 96.75%（95%CI 95.82% to 97.48%）,30 day rates of the end point events was 8.75%（95%CI 7.61% to 10.04%）,1 year rates of the end point events was 13%（95%CI 11.47% to 14.70%）,total mortality was 2.98%（95%CI 2.16% to 4.10%）,incidence of in-stent restenosis was 21.76%（95%CI 18.27% to 25.71%）,the ratio of the patients with symptomatic restenosis and total patients was 6.50%（95%CI 4.89% to 8.60%）,and the ratio of the patients with symptomatic restenosis and total patients with restenosis was 26.06%（95%CI 19.94% to 33.29%）. Conclusion Current evidence shows that treatment of ICAD by using Wingspan stents is effective and safe. However,this conclusion should be approved by further higher quality RCTs.

关 键 词：动脉粥样硬化 颅内动脉 WINGSPAN META分析 

分 类 号：R743[医药卫生—神经病学与精神病学]