Kevin Phan1, Adam A Dmytriw2, Julian Maingard3, Hamed Asadi4, Christoph J Griessenauer2, Wyatt Ng5, Kitso Kewagamang5, Ralph J Mobbs5, Justin M Moore2, Christopher S Ogilvy2, Ajith J Thomas2. 1. NeuroSpine Surgery Research Group, Sydney, Australia. Electronic address: kphan.vc@gmail.com. 2. Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 3. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia. 4. Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia. 5. NeuroSpine Surgery Research Group, Sydney, Australia.
Abstract
BACKGROUND: To date, no randomized trial has directly addressed the question of whether intravenous (IV) tissue plasminogen activator (tPA) improves outcomes in IV tPA-eligible patients who will eventually undergo endovascular therapy (EVT), or whether a direct EVT strategy is equally effective. We performed a systematic review and meta-analysis to compare the efficacy and safety of direct EVT versus endovascular treatment with IV tPA (EVT+IV tPA) in adults with acute ischemic stroke. METHODS: We performed electronic searches of 6 databases from their inception to January 2017. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Twelve comparative studies, comprising 1275 patients in the EVT-only arm and 1340 patients in the combined EVT+IV tPA arm, were included. The rates of good functional outcomes (modified Rankin Scale score ≤2) and 90-day mortality were not statistically significantly different between the EVT and EVT+IV tPA arms (44% vs. 48%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.64-1.002; P = 0.052 and 20.4% vs. 19.4%, OR 1.19; 95% CI, 0.83-1.71; P = 0.34, respectively). The rate of symptomatic intracranial hemorrhage also was not significantly different between the EVT and EVT+IV tPA arms (3.7% vs. 3.8%; OR, 0.98; 95% CI, 0.65-1.48; P = 0.91). There were no between-group differences in the rates of other complications. CONCLUSIONS: No significant differences between the 2 groups were found in terms of favorable functional outcome, mortality rate, or complications based on contemporary endovascular therapies.
BACKGROUND: To date, no randomized trial has directly addressed the question of whether intravenous (IV) tissue plasminogen activator (tPA) improves outcomes in IV tPA-eligible patients who will eventually undergo endovascular therapy (EVT), or whether a direct EVT strategy is equally effective. We performed a systematic review and meta-analysis to compare the efficacy and safety of direct EVT versus endovascular treatment with IV tPA (EVT+IV tPA) in adults with acute ischemic stroke. METHODS: We performed electronic searches of 6 databases from their inception to January 2017. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Twelve comparative studies, comprising 1275 patients in the EVT-only arm and 1340 patients in the combined EVT+IV tPA arm, were included. The rates of good functional outcomes (modified Rankin Scale score ≤2) and 90-day mortality were not statistically significantly different between the EVT and EVT+IV tPA arms (44% vs. 48%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.64-1.002; P = 0.052 and 20.4% vs. 19.4%, OR 1.19; 95% CI, 0.83-1.71; P = 0.34, respectively). The rate of symptomatic intracranial hemorrhage also was not significantly different between the EVT and EVT+IV tPA arms (3.7% vs. 3.8%; OR, 0.98; 95% CI, 0.65-1.48; P = 0.91). There were no between-group differences in the rates of other complications. CONCLUSIONS: No significant differences between the 2 groups were found in terms of favorable functional outcome, mortality rate, or complications based on contemporary endovascular therapies.
Authors: Guillaume Charbonnier; Louise Bonnet; Benjamin Bouamra; Fabrice Vuillier; Giovanni Vitale; Thierry Moulin; Elisabeth Medeiros De Bustos; Alessandra Biondi Journal: Cerebrovasc Dis Extra Date: 2020-04-28