缺血性卒中血管内血栓切除术后的认知结果：一项系统综述
Cognitive outcomes after endovascular thrombectomy in ischemic stroke: a systematic review.
摘要(中文译文)
血管内取栓术（EVT）是大血管闭塞（LVO）所致急性缺血性卒中的标准治疗方法，但其对认知功能的影响尚不十分明确，尽管卒中后认知障碍的患病率较高。我们系统综述了报告成人急性缺血性卒中患者接受EVT后客观测量的认知结局的随机对照试验和观察性研究。按照PRISMA 2020指南，于2025年3月1日至10月31日期间对PubMed、Embase、Cochrane Library和Scopus进行了系统检索，检索范围为2015年1月1日至2025年10月31日发表的研究。纳入的研究报告了EVT（联合或不联合静脉溶栓（IVT））后客观测量的卒中后认知结局。由于认知评估工具、结局定义和随访时间点存在显著异质性，无法进行定量合并，因此对结果进行了叙述性综合。共23项研究（约3，300名参与者；3项随机对照试验，20项观察性研究）符合纳入标准。在大多数比较性研究中，EVT与优于IVT或最佳药物治疗的认知结局相关，通常在早期至中期随访时蒙特利尔认知评估（MoCA）或简易精神状态检查（MMSE）评分平均高出1-4分。最一致的获益见于执行功能，对记忆的影响则较为多变但总体有利。较差的认知结局与较大的梗死体积、灰白质联合受累、区域性脑梗死模式以及较长的再灌注时间相关。探索性蛋白质组学研究提示炎症和神经营养标志物与认知恢复之间存在关联。尽管有这些获益，卒中后认知障碍仍然常见。血管内取栓术，尤其是快速实施并成功再灌注时，与更有利的认知结局相关，特别是在整体认知和执行功能方面。然而，持续性认知缺陷仍然常见，凸显了在未来EVT研究中开展标准化认知评估和长期随访的必要性。https://www.crd.york.ac.uk/PROSPERO/view/CRD420251156363，注册号CRD420251156363。
Abstract
Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke due to large-vessel occlusion (LVO), but its impact on cognition is less clearly defined despite the high prevalence of post-stroke cognitive impairment. We systematically reviewed randomized controlled trials and observational studies reporting objectively measured cognitive outcomes after EVT in adults with acute ischemic stroke. Following PRISMA 2020, a systematic search of PubMed, Embase, the Cochrane Library, and Scopus was conducted between 1 March and 31 October 2025 for studies published from 1 January 2015 to 31 October 2025. Eligible studies reported objectively measured post-stroke cognitive outcomes after EVT, with or without intravenous thrombolysis (IVT). Due to substantial heterogeneity in cognitive assessment tools, outcome definitions, and follow-up time points, quantitative pooling was not feasible and results were therefore synthesized narratively. Twenty-three studies (∼3,300 participants; 3 RCTs, 20 observational) met the inclusion criteria. Across most comparative studies, EVT was associated with better cognitive outcomes than IVT or best medical therapy, typically yielding on average 1-4 point higher scores on the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) at early to mid-term follow-up. The most consistent benefits were observed in executive functions, with more variable but favorable effects on memory. Worse cognitive outcomes were linked to larger infarct volume, combined gray-white matter involvement, territorial infarct patterns, and longer time to reperfusion. Exploratory proteomic work suggested associations between inflammatory and neurotrophic markers and cognitive recovery. Despite these benefits, post-stroke cognitive impairment remained frequent. Endovascular thrombectomy, particularly when performed rapidly with successful reperfusion, is associated with more favorable cognitive outcomes, especially in global cognition and executive function. However, persistent cognitive deficits remain common, highlighting the need for standardized cognitive assessment and longer-term follow-up in future EVT studies. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251156363, identifier CRD420251156363.
如何引用
AMA
Wiktoria Balcerzak, Gabriela Początek, Anetta Lasek-Bal, Agnieszka Gorzkowska. Cognitive outcomes after endovascular thrombectomy in ischemic stroke: a systematic review.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1787129.
APA
Wiktoria Balcerzak, Gabriela Początek, Anetta Lasek-Bal, Agnieszka Gorzkowska (2026). Cognitive outcomes after endovascular thrombectomy in ischemic stroke: a systematic review.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1787129
GB/T 7714
Wiktoria Balcerzak, Gabriela Początek, Anetta Lasek-Bal, Agnieszka Gorzkowska. Cognitive outcomes after endovascular thrombectomy in ischemic stroke: a systematic review.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1787129.
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