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Abstract
Background Risks and benefits of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) have been a topic of interest. However, IVT’s specific effects on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes remain largely unexplored. In this meta-analysis, we aimed to investigate the effects of IVT on SR and ASP thrombectomy outcomes.
Methods In accordance with PRISMA guidelines, a systematic literature review was conducted using Medline, Embase, Scopus, Web of Science, and Cochrane Center of Clinical Trials databases. Outcomes of interest included successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b), modified first pass efficacy (mFPE), functional independence (modified Rankin Scale (mRS) ≤2), symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT).
Results Four randomized controlled trials with 1176 patients were included. SR and ASP resulted in similar mTICI ≥2b, mFPE, and mRS 0–2 rates in patients with and without IVT administration. SR without IVT was associated with a significantly lower rate of mFPE compared with the SR+IVT (RR 0.85, 95% CI 0.74 to 0.97). Furthermore, ASP without IVT resulted in a lower rate of mRS 0–2 than the ASP+IVT with a strong trend towards significance (RR 0.78, 95% CI 0.60 to 1.01). Finally, bridging therapy did not increase sICH and ENT rates after ASP or SR thrombectomy.
Conclusions Our findings suggest that SR and ASP thrombectomy have comparable safety and efficacy profiles, regardless of prior IVT administration. Additionally, our results indicate that the addition of IVT may improve certain efficacy outcomes based on the employed first-line MT technique.
- Thrombectomy
- Stroke
- Thrombolysis
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Twitter @genius_elsho2a, @yigitcs
Contributors All authors contributed to the conception and design of the work. CB, HT, HK, AH, YCS, SA were responsible for data extraction, literature search, and risk of bias assessment. SG performed statistical analyses. All authors were involved in the drafting of the article, critical revision of the article, and final approval of the version to be published. CB and HT were equally contributing authors. CB is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests DFK received research support from Microvention, Medtronic, Neurogami, Cerenovus, Insera Therapeutics, Brainomix, MIVI Biosciences, and Stryker; received royalties from Medtronic; has ownership interest in Superior Medical Experts and Nested Knowledge, Marblehead Medical, Conway Medical, Monarch Biosciences, and Piraeus Medical; and serves on the advisory boards of Vesalio and NoNo Inc. RK received research support from Cerenovus, Medtronic, Endovascular Engineering, Frontier Bio, Sensome, Endomimetics, Ancure LLC, Neurogami Medical, MIVI Biosciences, Monarch Biosciences, Stryker, Conway Medical, Piraeus Medical, and Bionaut Labs.
Provenance and peer review Not commissioned; externally peer reviewed.
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