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Outcomes of mechanical thrombectomy with pre-intravenous thrombolysis: a systematic review and meta-analysis

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Abstract

Background and purpose

Whether pre-intravenous thrombolysis (IVT) provides any extra benefits to mechanical thrombectomy (MT) remains controversial. We conducted a systematic review and meta-analysis to compare MT with pre-IVT (IVT + MT) and MT without pre-IVT (MT) for acute ischemic stroke of large vessel occlusion.

Methods

We systematically searched PubMed, EMBASE and Cochrane Library to identify studies comparing outcomes between IVT + MT and MT from inception to Jan 24, 2019. Random effects mode was used to pool relative risk (RR) with confidence intervals (CI) to compare functional independence in terms of modified Rankin Scale (mRS) 0–2, favorable outcome (mRS 0–1) and mortality at three-months, symptomatic intracerebral hemorrhage, successful reperfusion, and complete reperfusion between the two treatments groups.

Results

We included 30 studies enrolling 8970 patients with acute ischemic stroke of large vessel occlusion. Compared with MT, IVT + MT significantly increased the rate of 3-month functional independence (RR 1.20, 95% CI 1.12–1.30;  P < 0.0001) and favorable outcome (RR 1.28; 95% CI 1.16–1.40; P < 0.0001), increased the rate of successful reperfusion (RR 1.04,95% CI 1.01–1.08;  P =  0.013) and complete reperfusion (RR 1.10; 95% CI 1.01–1.19; P = 0.024), reduced the rate of mortality (RR 0.74, 95% CI 0.67–0.82;  P < 0.0001), without significantly increasing the rate of symptomatic intracerebral hemorrhage (RR 0.98,95% CI 0.82–1.17;  P = 0.833). The results remained stable in sensitivity analyses and adjusting for publication bias.

Conclusions

Pre-IVT provides extra benefits to MT on clinical and imaging outcomes without increasing symptomatic intracerebral hemorrhage in acute ischemic stroke of large vessel occlusion.

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Authors and Affiliations

  1. Cerebrovascular Disease Center, Department of Neurology, People’s Hospital, China Medical University, 33 Wenyi Road, Shenyang, 110016, Shenhe District, People’s Republic of China

    Lu Fan, Lin Zang, Xiaodong Liu, Jian Wang, Jianting Qiu & Yujie Wang

  2. Dalian Medical University, 9 Western Sections, Lvshun South Street, Dalian, 116044, Lvshunkou District, People’s Republic of China

    Lu Fan, Lin Zang & Xiaodong Liu

  3. Neurosurgery Department, The First Hospital of China Medical University, 155 Nanjing North Road, Shenyang, 110001, Heping District, People’s Republic of China

    Jian Wang

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  1. Lu Fan
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  3. Xiaodong Liu
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  4. Jian Wang
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Contributions

LF, JW, and YJW contributed to the study conception and design. LF, LZ, and YJW did the systematic literature search, selected studies for inclusion and extracted data. LF, XDL and JW did statistical analyses and made the figures. LF, LZ, JTQ and YJW interpreted data. LF and YJW wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content, approved the final draft.

Corresponding author

Correspondence to Yujie Wang.

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Fan, L., Zang, L., Liu, X. et al. Outcomes of mechanical thrombectomy with pre-intravenous thrombolysis: a systematic review and meta-analysis. J Neurol 268, 2420–2428 (2021). https://doi.org/10.1007/s00415-020-09778-4

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  • DOI: https://doi.org/10.1007/s00415-020-09778-4

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