Introduction An updated analysis comparing endovascular thrombectomy (EVT) alone versus endovascular therapy without bridging intravenous thrombolysis (IVT) has not been performed.
Aim of Study To systematically update the evidence from randomized trials comparing endovascular thrombectomy (EVT) alone versus EVT with bridging intravenous thrombolysis (IVT).
Methods We searched MEDLINE, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT with or without IVT in patients with stroke secondary to a large vessel occlusion. We conducted meta-analyses using random-effects models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH), between EVT and EVT with IVT. We assessed risk of bias using the Cochrane risk-of-bias tool and certainty of evidence for each outcome using the GRADE approach.
Results Of 11,111 citations, we included 6 studies with a total of 2,336 participants. We found low-certainty evidence that there is possibly a small decrease in the proportion of patients with functional independence (risk difference [RD] -2.0%, 95% CI -5.9% to 2.0%), low-certainty evidence that there is possibly a small increase in mortality
(RD 1.0%, 95% CI -2.2% to 4.7%), and moderate-certainty evidence that there is probably a decrease in sICH (RD -1.0%, 95% CI -1.6% to 0.7%) for patients with
EVT alone compared to EVT plus IVT.
Conclusion Low-certainty evidence shows a small possible decrease in functional independence, low-certainty evidence shows a small possible decrease in mortality, and moderate-certainty evidence that there is probably a decrease in sICH for patients with EVT alone compared to EVT plus IVT.
Disclosure of Interest The authors have nothing to disclose.
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