Intravenous thrombolysis plus mechanical thrombectomy versus mechanical thrombectomy alone for acute ischemic stroke: A systematic review and updated meta-analysis of clinical trials

Elfil, Mohamed; Ghaith, Hazem S.; Elsayed, Hanaa; Aladawi, Mohammad; Elmashad, Ahmed; Patel, Neisha; Medicherla, Chaitanya; El‐Ghanem, Mohammad; Amuluru, Krishna; Al‐Mufti, Fawaz

doi:10.1177/15910199221140276

Cited by 8 publications

(3 citation statements)

References 38 publications

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“…Active research is ongoing in patients with MeVO, 55,[112][113][114][115][116][117][118][119] and new EVT techniques are evolving. [120][121][122][123][124][125][126]…”

Section: Gaps In Knowledgementioning

confidence: 99%

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

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The last decade's progress in demonstrating the clinical benefit of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke has transformed the paradigm of care for these patients. This review presents the milestones in implementing EVT as standard of care, demonstrates the current state of evidence, provides guidance for identifying the candidate patient for EVT, and highlights unsolved and controversial issues. Ongoing trials investigate broadening of EVT indications for patients who present with large core infarction, adjunctive intra-arterial thrombolysis, medium vessel occlusion, low NIHSS, and tandem occlusion.

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“…Active research is ongoing in patients with MeVO, 55,[112][113][114][115][116][117][118][119] and new EVT techniques are evolving. [120][121][122][123][124][125][126]…”

Section: Gaps In Knowledgementioning

confidence: 99%

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

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“…Recent meta-analyses and randomized clinical trials (RCTs) found no superiority or non-inferiority in functional outcome and mortality at 90 days between patients with a large vessel occlusion (LVO) treated with and without IVT prior to EVT. (2)(3)(4)(5)(6)(7)(8) These studies mainly concerned patients with anterior circulation occlusions.…”

Section: Introductionmentioning

confidence: 99%

Intravenous thrombolysis prior to endovascular treatment in posterior circulation occlusions; a MR CLEAN Registry study

Knapen

Pirson

Langezaal

et al. 2023

Preprint

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Background and aims<break><break>The effectiveness of intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT prior to EVT in posterior circulation occlusions in a nationwide registry. <break><break>Methods<break><break>Patients were included from the MR CLEAN Registry: a nationwide, prospective, multicenter registry of patients with acute ischemic stroke (AIS) due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift towards better functional outcome on the modified Rankin scale (mRS) at 90 days. Secondary outcomes were favorable functional outcome (mRS 0-3), occurrence of symptomatic intracranial hemorrhages (sICH), successful reperfusion (eTICI2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariate analyses and literature were applied. <break><break>Results<break><break>A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) prior to EVT. Results show no differences in a shift on the mRS (acOR:1.04, 95%CI:0.61-1.76). Although sICH occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (aOR:1.65, 95%CI:0.33-8.35). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. <break><break>Conclusions<break><break>We found no significant differences in clinical, technical and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT prior to endovascular therapy. Our results are in line with the literature on the anterior circulation.

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“…1 Recent meta-analyses and randomized clinical trials found no superiority or noninferiority in functional outcome and mortality at 90 days between patients with an LVO treated with and without IVT before EVT. [2][3][4][5][6][7][8] These studies mainly concerned patients with anterior circulation occlusions.…”

mentioning

confidence: 99%

Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study

Knapen,

Pirson,

Langezaal

et al. 2024

Stroke

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BACKGROUND: The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT before EVT in posterior circulation occlusions in a nationwide registry. METHODS: Patients were included from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), a nationwide, prospective, multicenter registry of patients with acute ischemic stroke due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Secondary outcomes were favorable functional outcome (modified Rankin Scale scores, 0–3), occurrence of symptomatic intracranial hemorrhages, successful reperfusion (extended Thrombolysis in Cerebral Ischemia ≥2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariable analyses and literature were applied. RESULTS: A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) before EVT. Results show no differences in a shift on the modified Rankin Scale (adjusted common odds ratio, 1.04 [95% CI, 0.61–1.76]). Although symptomatic intracranial hemorrhages occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (adjusted odds ratio, 1.65 [95% CI, 0.33–8.35]). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. CONCLUSIONS: We found no significant differences in clinical, technical, and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT before EVT. Our results are in line with the literature on the anterior circulation.

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Intravenous thrombolysis plus mechanical thrombectomy versus mechanical thrombectomy alone for acute ischemic stroke: A systematic review and updated meta-analysis of clinical trials

Cited by 8 publications

References 38 publications

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Intravenous thrombolysis prior to endovascular treatment in posterior circulation occlusions; a MR CLEAN Registry study

Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study

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