Hazem S Ghaith1,2, Mohamed Elfil2,3, Mohamed Diaa Gabra2,4, Asmaa Ahmed Nawar2,5, Mohamed Sameh Abd-Alkhaleq2,6, Khaled M Hamam2,6, Lara Ebrahim Aboelnasr2,7, Esraa Ayman Elgezery2,8, Mohamed Hosny Osman2,5, Hanaa Elsayed2,5, Sarya Swed2,9, Ulrick Sidney Kanmounye2,10, Ahmed Negida11,12,13,14. 1. Faculty of Medicine, Al-Azhar University, Cairo, Egypt. 2. Medical Research Group of Egypt, Cairo, Egypt. 3. Department of Neurological Sciences, University of Nebraska Medical Centre, Omaha, NE, USA. 4. Faculty of Medicine, South Valley University, Qena, Egypt. 5. Faculty of Medicine, Zagazig University, Zagazig, Egypt. 6. Faculty of Medicine, October 6 University, Giza, Egypt. 7. Faculty of Medicine, Misr University for Science and Technology, 6th October City, Egypt. 8. Faculty of Medicine, Menofia University, Menofia, Egypt. 9. Faculty of Medicine, Aleppo University, Aleppo, Syria. 10. Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon. 11. Medical Research Group of Egypt, Cairo, Egypt. ahmed_negida@hms.harvard.edu. 12. Faculty of Medicine, Zagazig University, Zagazig, Egypt. ahmed_negida@hms.harvard.edu. 13. School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK. ahmed_negida@hms.harvard.edu. 14. Department of Global Health, Harvard Medical School, Boston, MA, USA. ahmed_negida@hms.harvard.edu.
Abstract
BACKGROUND: The use of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a debatable subject in the field of neuro-interventional surgery. We conducted this systematic review and meta-analysis to synthesize evidence from published studies on the outcomes of IVT + MT compared with MT alone in AIS-LVO patients. METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to January 2022 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis DerSimonian-Liard random-effects model. RESULTS: Forty-nine studies, with a total of 36,123 patients, were included in this meta-analysis. IVT + MT was significantly superior to MT alone in terms of successful recanalization (RR 1.06, 95% CI 1.03 to 1.09), mortality (RR 0.75, 95% CI 0.68-0.82), favorable functional outcome (RR 1.21, 95% CI 1.13 to 1.29), and complete recanalization (RR 1.06, 95% CI 1.00 to 1.11). There were no significant differences between the two groups in terms of improvement of the National Institute of Health Stroke Scale (NIHSS) score at 24 h or at discharge (p > 0.05). Complications including symptomatic intracranial hemorrhage, symptomatic intracerebral hemorrhage (sICH), procedure-related complications, and parenchymal hematoma were comparable between the two groups (p > 0.05). CONCLUSION: For AIS-LVO, IVT + MT is associated with slightly better rates of survival, successful and complete recanalization, and favorable functional outcome as compared with MT alone. Further clinical trials are needed to corroborate such benefits of bridging IVT.
BACKGROUND: The use of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a debatable subject in the field of neuro-interventional surgery. We conducted this systematic review and meta-analysis to synthesize evidence from published studies on the outcomes of IVT + MT compared with MT alone in AIS-LVO patients. METHODS: We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to January 2022 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis DerSimonian-Liard random-effects model. RESULTS: Forty-nine studies, with a total of 36,123 patients, were included in this meta-analysis. IVT + MT was significantly superior to MT alone in terms of successful recanalization (RR 1.06, 95% CI 1.03 to 1.09), mortality (RR 0.75, 95% CI 0.68-0.82), favorable functional outcome (RR 1.21, 95% CI 1.13 to 1.29), and complete recanalization (RR 1.06, 95% CI 1.00 to 1.11). There were no significant differences between the two groups in terms of improvement of the National Institute of Health Stroke Scale (NIHSS) score at 24 h or at discharge (p > 0.05). Complications including symptomatic intracranial hemorrhage, symptomatic intracerebral hemorrhage (sICH), procedure-related complications, and parenchymal hematoma were comparable between the two groups (p > 0.05). CONCLUSION: For AIS-LVO, IVT + MT is associated with slightly better rates of survival, successful and complete recanalization, and favorable functional outcome as compared with MT alone. Further clinical trials are needed to corroborate such benefits of bridging IVT.
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