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World Neurosurg. 2017 Dec;108:850-858.e2. doi: 10.1016/j.wneu.2017.08.040. Epub 2017 Aug 18.

Endovascular Thrombectomy Alone versus Combined with Intravenous Thrombolysis.

Author information

1
NeuroSpine Surgery Research Group, Sydney, Australia. Electronic address: kphan.vc@gmail.com.
2
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
3
Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia.
4
Interventional Neuroradiology Service, Department of Radiology, Austin Hospital, Melbourne, Australia; Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia.
5
NeuroSpine Surgery Research Group, Sydney, Australia.

Abstract

BACKGROUND:

To date, no randomized trial has directly addressed the question of whether intravenous (IV) tissue plasminogen activator (tPA) improves outcomes in IV tPA-eligible patients who will eventually undergo endovascular therapy (EVT), or whether a direct EVT strategy is equally effective. We performed a systematic review and meta-analysis to compare the efficacy and safety of direct EVT versus endovascular treatment with IV tPA (EVT+IV tPA) in adults with acute ischemic stroke.

METHODS:

We performed electronic searches of 6 databases from their inception to January 2017. Data were extracted and analyzed according to predefined clinical endpoints.

RESULTS:

Twelve comparative studies, comprising 1275 patients in the EVT-only arm and 1340 patients in the combined EVT+IV tPA arm, were included. The rates of good functional outcomes (modified Rankin Scale score ≤2) and 90-day mortality were not statistically significantly different between the EVT and EVT+IV tPA arms (44% vs. 48%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.64-1.002; P = 0.052 and 20.4% vs. 19.4%, OR 1.19; 95% CI, 0.83-1.71; P = 0.34, respectively). The rate of symptomatic intracranial hemorrhage also was not significantly different between the EVT and EVT+IV tPA arms (3.7% vs. 3.8%; OR, 0.98; 95% CI, 0.65-1.48; P = 0.91). There were no between-group differences in the rates of other complications.

CONCLUSIONS:

No significant differences between the 2 groups were found in terms of favorable functional outcome, mortality rate, or complications based on contemporary endovascular therapies.

KEYWORDS:

Acute ischemic stroke; Endovascular; Occlusion; Stent retriever; Thrombectomy; Thrombolysis; Tissue plasminogen activator

PMID:
28823660
DOI:
10.1016/j.wneu.2017.08.040
[Indexed for MEDLINE]

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