TY - JOUR T1 - Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 1073 LP - 1080 DO - 10.1136/neurintsurg-2020-016680 VL - 13 IS - 12 AU - Johannes Kaesmacher AU - Thomas Raphael Meinel AU - Christoph Kurmann AU - Osama O Zaidat AU - Alicia C Castonguay AU - Syed F Zaidi AU - Nils Mueller-Kronast AU - Manon Kappelhof AU - Diederik W J Dippel AU - Marc Soudant AU - Serge Bracard AU - Michael D Hill AU - Mayank Goyal AU - Daniel Strbian AU - Daniel M Heiferman AU - William Ashley AU - Mohammad Anadani AU - Alejandro M Spiotta AU - Tomas Dobrocky AU - Eike I Piechowiak AU - Marcel Arnold AU - Martina Goeldlin AU - David Seiffge AU - Pascal J Mosimann AU - Pasquale Mordasini AU - Jan Gralla AU - Urs Fischer Y1 - 2021/12/01 UR - http://jnis.bmj.com/content/13/12/1073.abstract N2 - Background Achieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse.Methods We performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin Scale ≤2, mortality at 90 days).Results The search identified six observational cohort studies and three observational datasets of MT randomized-controlled trial data reporting on IA fibrinolytics with MT as compared with MT alone, including 2797 patients (405 with additional IA fibrinolytics (100 urokinase (uPA), 305 tissue plasminogen activator (tPA)) and 2392 patients without IA fibrinolytics). Of 405 MT patients treated with additional IA fibrinolytics, 209 (51.6%) received prior intravenous tPA. We did not observe an increased risk of sICH after administration of IA fibrinolytics as adjunct to MT (OR 1.06, 95% CI 0.64 to 1.76), nor excess mortality (0.81, 95% CI 0.60 to 1.08). Although the mode of reporting was heterogeneous, some studies observed improved reperfusion after IA fibrinolytics.Conclusion The quality of evidence regarding peri-interventional administration of IA fibrinolytics in MT is low and limited to observational data. In highly selected patients, no increase in sICH was observed, but there is large uncertainty.All data relevant to the study are included in the article or uploaded as supplementary information. All data included in the manuscript is visible in forest plot or has already been published in the referenced articles. ER -