Endovascular thrombectomy with or without thrombolysis bridging in patients with acute ischaemic stroke: protocol for a systematic review, meta-analysis of randomised trials and cost-effectiveness analysis

Abstract

IntroductionCurrent published guidelines and meta-analyses comparing endovascular thrombectomy (EVT) alone versus EVT with bridging intravenous thrombolysis (IVT) suggest that EVT alone is non-inferior to EVT with bridging thrombolysis in achieving favourable functional outcome. Because of this controversy, we aimed to systematically update the evidence and meta-analyse data from randomised trials comparing EVT alone versus EVT with bridging thrombolysis, and performed an economic evaluation comparing both strategies.Methods and analysisWe will conduct a systematic review of randomised controlled trials comparing EVT with or without bridging thrombolysis in patients presenting with large vessel occlusions. We will identify eligible studies by systematically searching the following databases from inception without any language restrictions: MEDLINE (through Ovid), Embase and the Cochrane Library. The following criteria will be used to assess eligibility for inclusion: (1) adult patients ≥18 years old; (2) randomised patients to EVT alone or to EVT with IVT; and (3) measured outcomes, including functional outcomes, at least 90 days after randomisation. Pairs of reviewers will independently screen the identified articles, extract information and assess the risk of bias of eligible studies. We will use the Cochrane Risk-of-Bias tool to evaluate risk of bias. We will also use the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty in evidence for each outcome. We will then perform an economic evaluation based on the extracted data.Ethics and disseminationThis systematic review will not require a research ethics approval because no confidential patient data will be used. We will disseminate our findings by publishing the results in a peer-reviewed journal and via presentation at conferences.PROSPERO registration numberCRD42022315608.

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

“…42 We registered the systematic review protocol on PROSPERO (CRD42022315608), and the protocol has been published. 43…”

“…The data used to support the findings of this study are available from the corresponding authors upon request by email. 43…”

Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis

“…We combined a decision tree for short-term and a Markov model for longterm costs and outcomes. The detailed protocol of the systematic review and this cost-utility analysis are described elsewhere [22].…”

“…For EVT-only strategy, patients received one or more of the following techniques for thrombectomy: stent retrievers, aspiration catheters, or both. For EVT plus IVT strategy, patients received IVT with a fibrinolytic agent (i.e., alteplase or tenecteplase) before the thrombectomy procedure as bridging therapy [22]. There was no consideration of timedependent treatment effects.…”