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

Lu Fan1,2, Lin Zang1,2, Xiaodong Liu1,2

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

Journal of Neurology
|March 7, 2020
PubMed
Abstract

Insights

Pre-intravenous thrombolysis (IVT) combined with mechanical thrombectomy (MT) improves functional outcomes and reperfusion rates for acute ischemic stroke. This combination therapy also reduces mortality without increasing the risk of symptomatic intracerebral hemorrhage.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Stroke Medicine

Background:

  • The efficacy of pre-intravenous thrombolysis (IVT) preceding mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) is debated.
  • Optimal treatment strategies for AIS-LVO require careful evaluation of combined therapies.

Purpose of the Study:

  • To systematically review and meta-analyze the benefits of MT with pre-IVT (IVT+MT) versus MT alone for AIS-LVO.
  • To compare clinical and imaging outcomes, including functional independence, mortality, and reperfusion rates.

Main Methods:

  • A systematic literature search of PubMed, EMBASE, and Cochrane Library was conducted up to January 24, 2019.
  • Random effects modeling was used to pool data from 30 studies involving 8970 patients.
  • Outcomes assessed included functional independence (mRS 0-2), favorable outcome (mRS 0-1), mortality, symptomatic intracerebral hemorrhage, and reperfusion success at three months.

Main Results:

  • IVT+MT significantly increased 3-month functional independence (RR 1.20) and favorable outcomes (RR 1.28) compared to MT alone.
  • The combination therapy also improved successful reperfusion (RR 1.04) and complete reperfusion (RR 1.10) rates.
  • IVT+MT significantly reduced mortality (RR 0.74) without a significant increase in symptomatic intracerebral hemorrhage (RR 0.98).

Conclusions:

  • Pre-IVT offers significant clinical and imaging benefits when combined with MT for acute ischemic stroke due to large vessel occlusion.
  • This combined approach enhances patient outcomes and reperfusion efficacy without elevating the risk of symptomatic intracerebral hemorrhage.
Keywords:
Functional independenceIntravenous thrombolysisMortalityStrokeSuccessful reperfusionSymptomatic intracerebral hemorrhageThrombectomy

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