Wen Hui1, Chuanjie Wu2,3, Wenbo Zhao2,3, Huan Sun4, Jun Hao1, Hongyan Liang1, Xian Wang5, Ming Li6, Ashutosh P Jadhav7, Youli Han1, Xunming Ji3,8. 1. School of Public Health (W.H., J.H., H.L., Y.H.), Capital Medical University, Beijing, China. 2. Department of Neurology, Xuanwu Hospital (C.W., W.Z.), Capital Medical University, Beijing, China. 3. Cerebrovascular Diseases Research Institute, Xuanwu Hospital (C.W., W.Z., X.J.), Capital Medical University, Beijing, China. 4. Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China (H.S.). 5. Center for Brain Disorders Research (X.W.), Capital Medical University, Beijing, China. 6. China-American Institute of Neuroscience, Xuanwu Hospital (M.L.),, Capital Medical University, Beijing, China. 7. UPMC Stroke Institute, Department of Neurology, University of Pittsburgh School of Medicine, PA (A.P.J.). 8. Department of Neurosurgery, Xuanwu Hospital (X.J.), Capital Medical University, Beijing, China.
Abstract
BACKGROUND AND PURPOSE: The optimal recanalization strategy for acute ischemic stroke with large vessel occlusion continues to be an area of active interest. Network meta-analysis can provide insight when direct comparative evidence is lacking. METHODS: A systematic review of the literature using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed was performed, and a search was conducted for clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and StrokeCenter.org. Four independent reviewers conducted the study selection, data abstraction, and quality assessments. RESULTS: The literature review identified 17 trials including 3236 patients and 8 ongoing clinical trials. Sample sizes ranged from 7 to 656 participants. Intravenous thrombolysis (IVT) was the most common intervention, followed by IVT plus mechanical thrombectomy (MT), IVT plus intraarterial thrombolysis, intraarterial thrombolysis alone, and MT alone. In the pooled network meta-analysis, IVT+MT was associated with a higher rate of independent functioning. In contrast, IVT was ranked as the most ineffective treatment strategy with respect to neurological functions, while direct MT was ranked as the least safe intervention with respect to all-cause mortality. Also, irrespective of assessment tools, endovascular treatment plus IVT led to higher successful recanalization rate than thrombolysis alone. CONCLUSIONS: Compared with other recanalization treatments, IVT+MT seems to be the most effective strategy, without increasing detrimental effects, for thrombolysis-eligible patients with large vessel occlusion-acute ischemic stroke. To improve the current evidentiary basis for recanalization treatment, future trials and real-world studies are warranted and should use unified definitions of symptomatic intracranial hemorrhage and recanalization.
BACKGROUND AND PURPOSE: The optimal recanalization strategy for acute ischemic stroke with large vessel occlusion continues to be an area of active interest. Network meta-analysis can provide insight when direct comparative evidence is lacking. METHODS: A systematic review of the literature using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed was performed, and a search was conducted for clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and StrokeCenter.org. Four independent reviewers conducted the study selection, data abstraction, and quality assessments. RESULTS: The literature review identified 17 trials including 3236 patients and 8 ongoing clinical trials. Sample sizes ranged from 7 to 656 participants. Intravenous thrombolysis (IVT) was the most common intervention, followed by IVT plus mechanical thrombectomy (MT), IVT plus intraarterial thrombolysis, intraarterial thrombolysis alone, and MT alone. In the pooled network meta-analysis, IVT+MT was associated with a higher rate of independent functioning. In contrast, IVT was ranked as the most ineffective treatment strategy with respect to neurological functions, while direct MT was ranked as the least safe intervention with respect to all-cause mortality. Also, irrespective of assessment tools, endovascular treatment plus IVT led to higher successful recanalization rate than thrombolysis alone. CONCLUSIONS: Compared with other recanalization treatments, IVT+MT seems to be the most effective strategy, without increasing detrimental effects, for thrombolysis-eligible patients with large vessel occlusion-acute ischemic stroke. To improve the current evidentiary basis for recanalization treatment, future trials and real-world studies are warranted and should use unified definitions of symptomatic intracranial hemorrhage and recanalization.
Authors: Roy El Koussa; Sarah Linder; Alicia Quayson; Shawn Banash; James J MacNeal; Parshva Shah; Mariaelana Brenner; Ross Levine; Osama O Zaidat; Vibhav Bansal Journal: Front Neurol Date: 2022-08-03 Impact factor: 4.086