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Direct endovascular treatment versus bridging therapy in patients with acute ischemic stroke eligible for intravenous thrombolysis: systematic review and meta-analysis
  1. Jian Zhang1,
  2. Shijian Chen1,
  3. Shengliang Shi2,
  4. Yueling Zhang2,
  5. Deyan Kong2,
  6. Yiju Xie1,
  7. Xuhui Deng1,
  8. Jian Tang2,
  9. Jinglian Luo2,
  10. Zhijian Liang1
  1. 1 Department of Neurology, Guangxi Medical University First Affiliated Hospital, Nanning, China
  2. 2 Department of Neurology, Guangxi Medical University Second Affiliated Hospital, Nanning, China
  1. Correspondence to Dr Zhijian Liang, Department of Neurology, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi, China; liangzhijian{at}


Objective In this review and meta-analysis we sought to compare the efficacy and safety of direct endovascular thrombectomy (EVT) and bridging therapy for intravenous thrombolysis (IVT)-eligible patients with acute ischemic stroke caused by large vessel occlusions (AIS-LVO).

Methods We searched Medline, Embase, and the Cochrane Library for published randomized clinical trials (RCTs) and observational studies providing outcomes of patients with IVT-eligible AIS-LVO who have undergone EVT with or without IVT. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 0–2 at 90 days. The secondary outcomes included the rates of (1) an excellent outcome defined as an mRS score of 0 or 1 at 90 days, (2) mortality at 90 days, (3) symptomatic intracranial hemorrhage (sICH), (4) any type of intracranial hemorrhage (ICH), (5) successful recanalization, and (6) clot migration.

Results We included three RCTs and six observational studies (4 of which were propensity score-adjusted studies) with a total of 3133 patients. In unadjusted and adjusted analyses, no differences in the rates of mRS scores 0–2, mRS scores 0–1, mortality at 90 days, sICH or successful recanalization were detected between patients with AIS-LVO who underwent direct EVT or bridging therapy. The patients treated with direct EVT had a lower risk ratio for any type of ICH and clot migration than did the patients treated with bridging therapy.

Conclusion Compared with bridging therapy, direct EVT may be equally effective and yield a lower rate of ICH and clot migration in patients with AIS.

Trail registration number PROSPERO: CRD42021236691.

  • thrombectomy

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  • JZ and SC are joint first authors.

  • JZ and SC contributed equally.

  • Contributors Guarantor of integrity of entire study: ZL. Study concept/study design: JZ, SC.SS, ZL. Data acquisition: all authors. Data extraction and analysis: JZ, SC, YZ, DK. Manuscript drafting: JZ. Manuscript revision for important intellectual content: all authors. Approval of final version of submitted manuscript: all authors. Statistical analysis: JZ, SC, SS. Manuscript editing: all authors. All authors agree to ensure any questions related to the work are appropriately resolved.

  • Funding The project was supported by the National Natural Science Foundation of China (No. 81801361).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.