Mechanical thrombectomy with intra-arterial thrombolysis versus mechanical thrombectomy alone in patients with acute ischemic stroke : A systematic review and meta-analysis
BACKGROUND: There is conflicting evidence as to whether intra-arterial thrombolysis (IAT) adds benefit in patients with acute stroke who undergo mechanical thrombectomy (MT).
METHODS: We conducted a systematic review to identify studies that evaluate IAT in patients with acute stroke who undergo MT. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until February 2023. Statistical pooling with random effects meta-analysis was undertaken to evaluate odds of functional independence, mortality, and near-complete or complete angiographic recanalization with IAT compared to no IAT.
RESULTS: A total of 18 studies were included (3 matched, 14 unmatched, and 1 randomized). The odds ratio (OR) for functional independence (modified Rankin Scale: 0-2) at 90 days was 1.14 (95% confidence interval (CI): 0.95-1.37, p = 0.17, 16 studies involving 7572 patients) with IAT with moderate between-study heterogeneity (I2 = 38.1%). The OR for functional independence with IAT was 1.28 (95% CI: 0.92-1.78, p = 0.15) in studies that were either matched or randomized and 1.24 (95% CI: 0.97-1.58, p = 0.08) in studies with the highest quality score. IAT was associated with higher odds of near-complete or complete angiographic recanalization (OR: 1.65, 95% CI: 1.03-2.65, p = 0.04) in studies that were either matched or of randomized comparisons.
CONCLUSION: Although the odds of functional independence appeared to be higher with IAT and MT compared with MT alone, none of the results were statistically significant. A prominent effect of the design and quality of the studies was observed on the association between IAT and functional independence at 90 days.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
International journal of stroke : official journal of the International Stroke Society - 19(2024), 1 vom: 29. Jan., Seite 16-28 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Qureshi, Adnan I [VerfasserIn] |
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| Links: |
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| Themen: |
Acute ischemic stroke |
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| Anmerkungen: |
Date Completed 02.01.2024 Date Revised 02.01.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/17474930231184369 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM358082056 |
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| 100 | 1 | |a Qureshi, Adnan I |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Mechanical thrombectomy with intra-arterial thrombolysis versus mechanical thrombectomy alone in patients with acute ischemic stroke |b A systematic review and meta-analysis |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 02.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: There is conflicting evidence as to whether intra-arterial thrombolysis (IAT) adds benefit in patients with acute stroke who undergo mechanical thrombectomy (MT) | ||
| 520 | |a METHODS: We conducted a systematic review to identify studies that evaluate IAT in patients with acute stroke who undergo MT. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until February 2023. Statistical pooling with random effects meta-analysis was undertaken to evaluate odds of functional independence, mortality, and near-complete or complete angiographic recanalization with IAT compared to no IAT | ||
| 520 | |a RESULTS: A total of 18 studies were included (3 matched, 14 unmatched, and 1 randomized). The odds ratio (OR) for functional independence (modified Rankin Scale: 0-2) at 90 days was 1.14 (95% confidence interval (CI): 0.95-1.37, p = 0.17, 16 studies involving 7572 patients) with IAT with moderate between-study heterogeneity (I2 = 38.1%). The OR for functional independence with IAT was 1.28 (95% CI: 0.92-1.78, p = 0.15) in studies that were either matched or randomized and 1.24 (95% CI: 0.97-1.58, p = 0.08) in studies with the highest quality score. IAT was associated with higher odds of near-complete or complete angiographic recanalization (OR: 1.65, 95% CI: 1.03-2.65, p = 0.04) in studies that were either matched or of randomized comparisons | ||
| 520 | |a CONCLUSION: Although the odds of functional independence appeared to be higher with IAT and MT compared with MT alone, none of the results were statistically significant. A prominent effect of the design and quality of the studies was observed on the association between IAT and functional independence at 90 days | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Systematic review | |
| 650 | 4 | |a acute ischemic stroke | |
| 650 | 4 | |a intra-arterial thrombolysis | |
| 650 | 4 | |a mechanical thrombectomy | |
| 650 | 4 | |a meta-analysis | |
| 700 | 1 | |a Lodhi, Abdullah |e verfasserin |4 aut | |
| 700 | 1 | |a Akhtar, Iqra N |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Xiaoyu |e verfasserin |4 aut | |
| 700 | 1 | |a Kherani, Danish |e verfasserin |4 aut | |
| 700 | 1 | |a Kwok, Chun Shing |e verfasserin |4 aut | |
| 700 | 1 | |a Ford, Daniel E |e verfasserin |4 aut | |
| 700 | 1 | |a Hanley, Daniel F |e verfasserin |4 aut | |
| 700 | 1 | |a Hassan, Ameer E |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Thanh N |e verfasserin |4 aut | |
| 700 | 1 | |a Spiotta, Alejandro M |e verfasserin |4 aut | |
| 700 | 1 | |a Zaidi, Syed F |e verfasserin |4 aut | |
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