Endovascular Thrombectomy With or Without Thrombolysis for Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

被引：4

作者：

Morsi, Rami Z. ^{[1
]}

Zhang, Yuan ^{[2
]}

Carrion-Penagos, Julian ^{[1
]}

Desai, Harsh ^{[1
]}

Tannous, Elie ^{[3
]}

Kothari, Sachin ^{[1
]}

Khamis, Assem ^{[4
]}

Darzi, Andrea J. ^{[2
]}

Tarabichi, Ammar ^{[1
]}

Bastin, Reena ^{[1
]}

Hneiny, Layal ^{[5
]}

Thind, Sonam ^{[6
]}

Coleman, Elisheva ^{[1
]}

Brorson, James R. ^{[1
]}

Mendelson, Scott ^{[1
]}

Mansour, Ali ^{[1
]}

Prabhakaran, Shyam ^{[1
]}

Kass-Hout, Tareq ^{[1
,6
,7
]}

机构：

[1] Univ Chicago, Dept Neurol, Chicago, IL 60637 USA

[2] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[3] Albany Med Ctr, Dept Pathol, Albany, NY USA

[4] Univ Hull, Wolfson Palliat Care Res Ctr, Hull York Med Sch, Kingston Upon Hull, England

[5] Univ South Dakota, Wegner Hlth Sci Informat Ctr, Sioux Falls, SD USA

[6] Univ Chicago, Dept Surg, Sect Neurosurg, Chicago, IL 60637 USA

[7] Univ Chicago, Dept Neurol, Dept Surg, Sect Neurosurg, 5941 S Maryland Ave,MC 2030, Chicago, IL 60637 USA

来源：

NEUROHOSPITALIST | 2023年

关键词：

thrombectomy; thrombolysis; stroke; systematic review; GRADE; ACUTE ISCHEMIC-STROKE; LARGE-VESSEL OCCLUSION; INTRAVENOUS T-PA; MECHANICAL THROMBECTOMY; ALTEPLASE; RECANALIZATION; OUTCOMES; THERAPY; REPERFUSION; GRADE;

D O I：

10.1177/19418744231200046

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: To this date, whether to administer intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for stroke patients still stirs some debate. We aimed to systematically update the evidence from randomized trials comparing EVT alone vs EVT with bridging IVT. Methods: We searched MEDLINE, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT with or without IVT in patients presenting 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 2336 participants. We found low-certainty evidence of 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%), andmoderate-certainty evidence that there is probably a decrease in sICH (RD -1.0%, 95% CI-1.6% to.7%) for patientswith EVT alone compared to EVT plus IVT, respectively. Conclusion: Low-certainty evidence shows that there is possibly a small decrease in functional independence, low-certainty evidence shows that there is possibly a small increase in mortality, and moderate-certainty evidence that there is probably a decrease in sICH for patients with EVT alone compared to EVT plus IVT.

引用

页码：23 / 33

页数：11

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