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

• Published in: Neurological sciences Vol. 43; no. 11; pp. 6243 - 6269
• Main Authors: Ghaith, Hazem S., Elfil, Mohamed, Gabra, Mohamed Diaa, Nawar, Asmaa Ahmed, Abd-Alkhaleq, Mohamed Sameh, Hamam, Khaled M., Aboelnasr, Lara Ebrahim, Elgezery, Esraa Ayman, Osman, Mohamed Hosny, Elsayed, Hanaa, Swed, Sarya, Kanmounye, Ulrick Sidney, Negida, Ahmed
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2022; Springer Nature B.V
• Subjects: Clinical trials; Hematoma; Hemorrhage; Intravenous administration; Ischemia; Medicine; Medicine & Public Health; Meta-analysis; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Occlusion; Patients; Psychiatry; Review Article; Stroke; Systematic review; Thrombolysis; Endovascular thrombectomy; Systematic review; Mechanical thrombectomy; Acute ischemic stroke; Intravenous thrombolysis; Meta-analysis
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-022-06283-6

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.