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Intravenous thrombolysis before mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion; should we cross that bridge? A systematic review and meta-analysis of 36,123 patients

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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.

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Abbreviations

AIS:

Acute ischemic stroke

AIS-LVO:

Acute ischemic stroke due to large vessel occlusion

CI:

Confidence interval

EVT:

Endovascular therapy

IVT:

Intravenous thrombolysis

LVO:

Large vessel occlusion

MD:

Mean difference

MT:

Mechanical thrombectomy

mTICI:

Modified Thrombolysis in Cerebral Infarction grade

NIHSS:

National Institute of Health Stroke Score

RCT:

Randomized-controlled trials

RR:

Risk Ratio

IV:

Inverse variance (meta-analysis method)

M-H:

Mantel-Haenszel (meta-analysis method)

References

  1. Tsivgoulis G, Safouris A, Alexandrov AV (2015) Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions. Expert Opin Drug Saf 14:845–864. https://doi.org/10.1517/14740338.2015.1032242

    Article  CAS  PubMed  Google Scholar 

  2. Seners P, Turc G, Maïer B et al (2016) Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke 47:2409–2412. https://doi.org/10.1161/STROKEAHA.116.014181

    Article  CAS  PubMed  Google Scholar 

  3. Whiteley WN, Emberson J, Lees KR et al (2016) Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis. Lancet Neurol 15:925–933. https://doi.org/10.1016/S1474-4422(16)30076-X

    Article  PubMed  Google Scholar 

  4. Bhatia R, Hill MD, Shobha N et al (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41:2254–2258. https://doi.org/10.1161/STROKEAHA.110.592535

    Article  CAS  PubMed  Google Scholar 

  5. Campbell BCV, Mitchell PJ, Kleinig TJ et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372:1009–1018. https://doi.org/10.1056/NEJMoa1414792

    Article  CAS  PubMed  Google Scholar 

  6. Powers WJ, Rabinstein AA, Ackerson T et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke. Stroke 50:e344–e418

    Article  PubMed  Google Scholar 

  7. Broeg-Morvay A, Mordasini P, Bernasconi C et al (2016) Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis. Stroke 47:1037–1044. https://doi.org/10.1161/STROKEAHA.115.011134

    Article  PubMed  Google Scholar 

  8. Balodis A, Radzina M, Miglane E et al (2019) Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis. Acta Radiol 60:308–314. https://doi.org/10.1177/0284185118780897

    Article  PubMed  Google Scholar 

  9. Jian Y, Zhao L, Jia B et al (2021) Direct versus bridging mechanical thrombectomy in elderly patients with acute large vessel occlusion: a multicenter cohort study. Clin Interv Aging 16:1265–1274. https://doi.org/10.2147/CIA.S313171

    Article  PubMed  PubMed Central  Google Scholar 

  10. Casetta I, Pracucci G, Saletti A et al (2019) Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke. Int J stroke Off J Int Stroke Soc 14:898–907. https://doi.org/10.1177/1747493019851279

    Article  Google Scholar 

  11. Chalos V, LeCouffe NE, Uyttenboogaart M et al (2019) Endovascular treatment with or without prior intravenous alteplase for acute ischemic stroke. J Am Heart Assoc 8:e011592. https://doi.org/10.1161/JAHA.118.011592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Merlino G, Sponza M, Petralia B et al (2017) Short and long-term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy: a prospective single-center study. J Thromb Thrombolysis 44:203–209. https://doi.org/10.1007/s11239-017-1527-8

    Article  CAS  PubMed  Google Scholar 

  13. Minnerup J, Wersching H, Teuber A et al (2016) Outcome after thrombectomy and intravenous thrombolysis in patients with acute ischemic stroke: a prospective observational study. Stroke 47:1584–1592. https://doi.org/10.1161/STROKEAHA.116.012619

    Article  CAS  PubMed  Google Scholar 

  14. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700–b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yang P, Zhang Y, Zhang L et al (2020) Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 382:1981–1993. https://doi.org/10.1056/NEJMoa2001123

    Article  CAS  PubMed  Google Scholar 

  16. Leker RR, Pikis S, Gomori JM, Cohen JE (2015) Is bridging necessary? A pilot study of bridging versus primary stentriever-based endovascular reperfusion in large anterior circulation strokes. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 24:1163–1167. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.01.008

    Article  Google Scholar 

  17. Mistry EA, Mistry AM, Nakawah MO et al (2017) Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Stroke 48:2450–2456. https://doi.org/10.1161/STROKEAHA.117.017320

    Article  PubMed  Google Scholar 

  18. Machado M, Alves M, Fior A et al (2021) Functional outcome after mechanical thrombectomy with or without previous thrombolysis. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 30:105495. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105495

    Article  Google Scholar 

  19. Maier IL, Behme D, Schnieder M et al (2017) Bridging-therapy with intravenous recombinant tissue plasminogen activator improves functional outcome in patients with endovascular treatment in acute stroke. J Neurol Sci 372:300–304. https://doi.org/10.1016/j.jns.2016.12.001

    Article  CAS  PubMed  Google Scholar 

  20. Di Maria F, Mazighi M, Kyheng M et al (2018) Intravenous thrombolysis prior to mechanical thrombectomy in acute ischemic stroke: silver bullet or useless bystander? J stroke 20:385–393. https://doi.org/10.5853/jos.2018.01543

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pienimäki J-P, Ollikainen J, Sillanpää N, Protto S (2021) In-hospital intravenous thrombolysis offers no benefit in mechanical thrombectomy in optimized tertiary stroke center setting. Cardiovasc Intervent Radiol 44:580–586. https://doi.org/10.1007/s00270-020-02727-8

    Article  PubMed  Google Scholar 

  22. Rossi R, Fitzgerald S, Molina S et al (2021) The administration of rtPA before mechanical thrombectomy in acute ischemic stroke patients is associated with a significant reduction of the retrieved clot area but it does not influence revascularization outcome. J Thromb Thrombolysis 51:545–551. https://doi.org/10.1007/s11239-020-02279-1

    Article  CAS  PubMed  Google Scholar 

  23. Sallustio F, Koch G, Alemseged F et al (2018) Effect of mechanical thrombectomy alone or in combination with intravenous thrombolysis for acute ischemic stroke. J Neurol 265:2875–2880. https://doi.org/10.1007/s00415-018-9073-7

    Article  CAS  PubMed  Google Scholar 

  24. Suzuki K, Matsumaru Y, Takeuchi M et al (2021) Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: The SKIP Randomized Clinical Trial. JAMA 325:244–253. https://doi.org/10.1001/jama.2020.23522

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tajima Y, Hayasaka M, Ebihara K et al (2019) Effectiveness of low-dose intravenous tissue plasminogen activator before stent retriever or aspiration mechanical thrombectomy. J Vasc Interv Radiol 30:134–140. https://doi.org/10.1016/j.jvir.2018.11.005

    Article  PubMed  Google Scholar 

  26. Wang H, Zi W, Hao Y et al (2017) Direct endovascular treatment: an alternative for bridging therapy in anterior circulation large-vessel occlusion stroke. Eur J Neurol 24:935–943. https://doi.org/10.1111/ene.13311

    Article  CAS  PubMed  Google Scholar 

  27. Weber R, Nordmeyer H, Hadisurya J et al (2017) Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J Neurointerv Surg 9:229–233. https://doi.org/10.1136/neurintsurg-2015-012236

    Article  PubMed  Google Scholar 

  28. Wee C-K, McAuliffe W, Phatouros CC et al (2017) Outcomes of endovascular thrombectomy with and without thrombolysis for acute large artery ischaemic stroke at a tertiary stroke centre. Cerebrovasc Dis Extra 7:95–102. https://doi.org/10.1159/000470855

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yi T-Y, Chen W-H, Wu Y-M et al (2018) Adjuvant intra-arterial rt-PA injection at the initially deployed solitaire stent enhances the efficacy of mechanical thrombectomy in acute ischemic stroke. J Neurol Sci 386:69–73. https://doi.org/10.1016/j.jns.2018.01.012

    Article  CAS  PubMed  Google Scholar 

  30. Zi W, Qiu Z, Li F et al (2021) Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA 325:234–243. https://doi.org/10.1001/jama.2020.23523

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Al-Khaled M, Brüning T, Gottwald C et al (2018) Comparing outcome and recanalization results in patients with anterior circulation stroke following endovascular treatment with and without a treatment with rt-PA: A single-center study. Brain Behav 8:e00974. https://doi.org/10.1002/brb3.974

    Article  PubMed  PubMed Central  Google Scholar 

  32. Behme D, Kabbasch C, Kowoll A et al (2016) Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 25:954–959. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.007

    Article  Google Scholar 

  33. Broocks G, Meyer L, Kabiri R et al (2021) Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy. Eur Radiol 31:8228–8235. https://doi.org/10.1007/s00330-021-07980-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Charbonnier G, Bonnet L, Bouamra B et al (2020) Does intravenous thrombolysis influence the time of recanalization and success of mechanical thrombectomy during the acute phase of cerebral infarction? Cerebrovasc Dis Extra 10:28–35. https://doi.org/10.1159/000507119

    Article  PubMed  PubMed Central  Google Scholar 

  35. Choi JH, Im SH, Lee KJ et al (2018) Comparison of outcomes after mechanical thrombectomy alone or combined with intravenous thrombolysis and mechanical thrombectomy for patients with acute ischemic stroke due to large vessel occlusion. World Neurosurg 114:e165–e172. https://doi.org/10.1016/j.wneu.2018.02.126

    Article  PubMed  Google Scholar 

  36. Gamba M, Gilberti N, Premi E et al (2019) Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results. BMC Neurol 19:103. https://doi.org/10.1186/s12883-019-1341-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Guedin P, Larcher A, Decroix J-P et al (2015) Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 24:952–957. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.12.015

    Article  Google Scholar 

  38. Guimarães Rocha M, Carvalho A, Rodrigues M et al (2019) Primary thrombectomy versus combined mechanical thrombectomy and intravenous thrombolysis in large vessel occlusion acute ischemic Stroke. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 28:627–631. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.002

    Article  Google Scholar 

  39. Heiferman DM, Li DD, Pecoraro NC et al (2017) Intra-arterial alteplase thrombolysis during mechanical thrombectomy for acute ischemic stroke. J stroke Cerebrovasc Dis Off J Natl Stroke Assoc 26:3004–3008. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.07.031

    Article  Google Scholar 

  40. Imbarrato G, Bentley J, Gordhan A (2018) Clinical outcomes of endovascular thrombectomy in tissue plasminogen activator versus non-tissue plasminogen activator patients at primary stroke care centers. J Neurosci Rural Pract 9:240–244. https://doi.org/10.4103/jnrp.jnrp_497_17

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kaesmacher J, Kleine JF (2018) Bridging therapy with i. v. rtPA in MCA occlusion prior to endovascular thrombectomy: a Double-Edged Sword? Clin Neuroradiol 28:81–89. https://doi.org/10.1007/s00062-016-0533-0

    Article  PubMed  Google Scholar 

  42. Abilleira S, Ribera A, Cardona P et al (2017) Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different. Stroke 48:375–378. https://doi.org/10.1161/STROKEAHA.116.015857

    Article  PubMed  Google Scholar 

  43. Bhatia R, Shobha N, Menon BK et al (2014) Combined full-dose IV and endovascular thrombolysis in acute ischaemic stroke. Int J stroke Off J Int Stroke Soc 9:974–979. https://doi.org/10.1111/j.1747-4949.2012.00890.x

    Article  Google Scholar 

  44. Dávalos A, Pereira VM, Chapot R et al (2012) Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 43:2699–2705. https://doi.org/10.1161/STROKEAHA.112.663328

    Article  PubMed  Google Scholar 

  45. Kass-Hout T, Kass-Hout O, Mokin M et al (2014) Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke? World Neurosurg 82:e453–e458. https://doi.org/10.1016/j.wneu.2013.01.097

    Article  PubMed  Google Scholar 

  46. Pfefferkorn T, Holtmannspötter M, Patzig M et al (2012) Preceding intravenous thrombolysis facilitates endovascular mechanical recanalization in large intracranial artery occlusion. Int J stroke Off J Int Stroke Soc 7:14–18. https://doi.org/10.1111/j.1747-4949.2011.00639.x

    Article  Google Scholar 

  47. Rai AT, Boo S, Buseman C et al (2018) Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J Neurointerv Surg 10:17–21. https://doi.org/10.1136/neurintsurg-2016-012830

    Article  PubMed  Google Scholar 

  48. Gong L, Zheng X, Feng L et al (2019) Bridging therapy versus direct mechanical thrombectomy in patients with acute ischemic stroke due to middle cerebral artery occlusion: a clinical-histological analysis of retrieved thrombi. Cell Transplant 28:684–690. https://doi.org/10.1177/0963689718823206

    Article  PubMed  PubMed Central  Google Scholar 

  49. Alonso de Leciñana M, Martínez-Sánchez P, García-Pastor A et al (2017) Mechanical thrombectomy in patients with medical contraindications for intravenous thrombolysis: a prospective observational study. J Neurointerv Surg 9:1041–1046. https://doi.org/10.1136/neurintsurg-2016-012727

    Article  PubMed  Google Scholar 

  50. Bourcier R, Alexandre P-L, Eugène F et al (2018) Is bridging therapy still required in stroke due to carotid artery terminus occlusions? J Neurointerv Surg 10:625–628. https://doi.org/10.1136/neurintsurg-2017-013398

    Article  PubMed  Google Scholar 

  51. Ferrigno M, Bricout N, Leys D et al (2018) Intravenous recombinant tissue-type plasminogen activator: influence on outcome in anterior circulation ischemic stroke treated by mechanical thrombectomy. Stroke 49:1377–1385. https://doi.org/10.1161/STROKEAHA.118.020490

    Article  CAS  PubMed  Google Scholar 

  52. Maingard J, Shvarts Y, Motyer R et al (2019) Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke. Intern Med J 49:345–351. https://doi.org/10.1111/imj.14069

    Article  CAS  PubMed  Google Scholar 

  53. Park H-K, Chung J-W, Hong J-H et al (2017) Preceding intravenous thrombolysis in patients receiving endovascular therapy. Cerebrovasc Dis 44:51–58. https://doi.org/10.1159/000471492

    Article  PubMed  Google Scholar 

  54. LeCouffe NE, Kappelhof M, Treurniet KM et al (2021) A randomized trial of intravenous alteplase before endovascular treatment for stroke. N Engl J Med 385:1833–1844. https://doi.org/10.1056/NEJMoa2107727

    Article  CAS  PubMed  Google Scholar 

  55. Goyal N, Tsivgoulis G, Frei D et al (2018) Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion. Neurology 90:e1274–e1282. https://doi.org/10.1212/WNL.0000000000005299

    Article  PubMed  Google Scholar 

  56. Tong X, Wang Y, Fiehler J et al (2021) Thrombectomy versus combined thrombolysis and thrombectomy in patients with acute stroke: a matched-control study. Stroke 52:1589–1600. https://doi.org/10.1161/STROKEAHA.120.031599

    Article  PubMed  Google Scholar 

  57. Kandregula S, Savardekar AR, Sharma P et al (2021) Direct thrombectomy versus bridging thrombolysis with mechanical thrombectomy in middle cerebral artery stroke: a real-world analysis through National Inpatient Sample data. Neurosurg Focus 51:E4. https://doi.org/10.3171/2021.4.FOCUS21132

    Article  PubMed  Google Scholar 

  58. Podlasek A, Dhillon PS, Butt W et al (2021) Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: A meta-analysis of randomized controlled trials. Int J stroke Off J Int Stroke Soc 16:621–631. https://doi.org/10.1177/17474930211021353

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  60. Vidale S, Romoli M, Consoli D, Agostoni EC (2020) Bridging versus direct mechanical thrombectomy in acute ischemic stroke: a subgroup pooled meta-analysis for time of intervention, eligibility, and study design. Cerebrovasc Dis 49:223–232. https://doi.org/10.1159/000507844

    Article  PubMed  Google Scholar 

  61. Katsanos AH, Malhotra K, Goyal N et al (2019) Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions. Ann Neurol 86:395–406. https://doi.org/10.1002/ana.25544

    Article  PubMed  Google Scholar 

  62. Phan K, Dmytriw AA, Maingard J et al (2017) Endovascular thrombectomy alone versus combined with intravenous thrombolysis. World Neurosurg 108:850-858.e2. https://doi.org/10.1016/j.wneu.2017.08.040

    Article  PubMed  Google Scholar 

  63. Tsivgoulis G, Katsanos AH, Mavridis D et al (2016) Mechanical Thrombectomy improves functional outcomes independent of pretreatment with intravenous thrombolysis. Stroke 47:1661–1664. https://doi.org/10.1161/STROKEAHA.116.013097

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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None. This study is not funded by a third party.

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Authors and Affiliations

  1. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Hazem S. Ghaith

  2. Medical Research Group of Egypt, Cairo, Egypt

    Hazem S. Ghaith, Mohamed Elfil, Mohamed Diaa Gabra, Asmaa Ahmed Nawar, Mohamed Sameh Abd-Alkhaleq, Khaled M. Hamam, Lara Ebrahim Aboelnasr, Esraa Ayman Elgezery, Mohamed Hosny Osman, Hanaa Elsayed, Sarya Swed, Ulrick Sidney Kanmounye & Ahmed Negida

  3. Department of Neurological Sciences, University of Nebraska Medical Centre, Omaha, NE, USA

    Mohamed Elfil

  4. Faculty of Medicine, South Valley University, Qena, Egypt

    Mohamed Diaa Gabra

  5. Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Asmaa Ahmed Nawar, Mohamed Hosny Osman, Hanaa Elsayed & Ahmed Negida

  6. Faculty of Medicine, October 6 University, Giza, Egypt

    Mohamed Sameh Abd-Alkhaleq & Khaled M. Hamam

  7. Faculty of Medicine, Misr University for Science and Technology, 6th October City, Egypt

    Lara Ebrahim Aboelnasr

  8. Faculty of Medicine, Menofia University, Menofia, Egypt

    Esraa Ayman Elgezery

  9. Faculty of Medicine, Aleppo University, Aleppo, Syria

    Sarya Swed

  10. Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon

    Ulrick Sidney Kanmounye

  11. School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK

    Ahmed Negida

  12. Department of Global Health, Harvard Medical School, Boston, MA, USA

    Ahmed Negida

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Ghaith, H.S., Elfil, M., Gabra, M.D. et al. Intravenous thrombolysis before mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion; should we cross that bridge? A systematic review and meta-analysis of 36,123 patients. Neurol Sci 43, 6243–6269 (2022). https://doi.org/10.1007/s10072-022-06283-6

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