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Effects of intravenous thrombolysis on stent retriever and aspiration thrombectomy outcomes: a systematic review and meta-analysis of the randomized controlled trials
  1. Cem Bilgin1,
  2. Hatem Tolba2,
  3. Sherief Ghozy1,
  4. Hassan Kobeissi3,
  5. Amir Hassankhani1,
  6. Yigit Can Senol4,
  7. Santhosh Arul1,
  8. Ramanathan Kadirvel4,
  9. David F Kallmes1
  1. 1 Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2 Department of Neurology, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
  3. 3 Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
  4. 4 Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr Cem Bilgin, Department of Radiology, Mayo Clinic Rochester, Rochester, MN, 55905, USA; bilgin.cem{at}


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.

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  • 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.

  • 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.