Xin Wu1,2, Yi Ge3, Shujun Chen3, Zeya Yan1, Zilan Wang1, Wei Zhang2, Zhouqing Chen1, Tao Xue4,5, Zhong Wang6. 1. Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China. 2. Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, 215200, China. 3. Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu Province, China. 4. Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China. 2992326676@qq.com. 5. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100000, China. 2992326676@qq.com. 6. Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China. wangzhong761@163.com.
Abstract
BACKGROUND: Recently, several randomized controlled trials (RCTs) about direct mechanical thrombectomy (d-MT) vs. intravenous thrombolysis before MT (IVT + MT) for acute ischemic stroke (AIS) patients have been reported. This study aims to investigate the differences in efficacy and safety of MT with or without IVT for the treatment of patients with AIS. METHODS: MEDLINE, EMBASE, Cochrane Library and Clinicaltrials.gov from March 2011 to February 2021 were systematically searched for studies comparing the two strategies directly. Review Manager 5.3 software was used to assess the risk of bias and pool the data with a random effect model. RESULTS: We pooled 1633 patients from 4 RCTs. The primary outcome, proportion of patients achieving functional independence (mRS0-2) at 90 days, was not significantly different between the two groups (MT 46.02% vs. IVT + MT 45.47%, OR 1.02; 95% CI 0.84-1.25). However, the risk of developing any ICH was lower in the d-MT group (RR 0.75; 95% CI 0.63-0.89). In addition, the remaining secondary outcomes, such as successful reperfusion (eTICI scale, 2b-3) at final angiogram (OR 0.80; 95% CI, 0.62-1.03) and mortality at 90 days (RR 1.06; 95% CI 0.85-1.31), did not differ between the groups. CONCLUSIONS: Outcomes were similar for d-MT and IVT + MT, with d-MT having a lower risk of any ICH. We need to focus on precision medicine in the future. REGISTRATION: URL: http://inplasy.com ; Unique identifier: INPLASY202130094.
BACKGROUND: Recently, several randomized controlled trials (RCTs) about direct mechanical thrombectomy (d-MT) vs. intravenous thrombolysis before MT (IVT + MT) for acute ischemic stroke (AIS) patients have been reported. This study aims to investigate the differences in efficacy and safety of MT with or without IVT for the treatment of patients with AIS. METHODS: MEDLINE, EMBASE, Cochrane Library and Clinicaltrials.gov from March 2011 to February 2021 were systematically searched for studies comparing the two strategies directly. Review Manager 5.3 software was used to assess the risk of bias and pool the data with a random effect model. RESULTS: We pooled 1633 patients from 4 RCTs. The primary outcome, proportion of patients achieving functional independence (mRS0-2) at 90 days, was not significantly different between the two groups (MT 46.02% vs. IVT + MT 45.47%, OR 1.02; 95% CI 0.84-1.25). However, the risk of developing any ICH was lower in the d-MT group (RR 0.75; 95% CI 0.63-0.89). In addition, the remaining secondary outcomes, such as successful reperfusion (eTICI scale, 2b-3) at final angiogram (OR 0.80; 95% CI, 0.62-1.03) and mortality at 90 days (RR 1.06; 95% CI 0.85-1.31), did not differ between the groups. CONCLUSIONS: Outcomes were similar for d-MT and IVT + MT, with d-MT having a lower risk of any ICH. We need to focus on precision medicine in the future. REGISTRATION: URL: http://inplasy.com ; Unique identifier: INPLASY202130094.