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Endovascular thrombectomy alone versus combined with intravenous thrombolysis

journal contribution
posted on 2017-12-01, 00:00 authored by Kevin Phan, Adam A Dmytriw, Julian MaingardJulian Maingard, Hamed AsadiHamed Asadi, Christoph J Griessenauer, Wyatt Ng, Kitso Kewagamang, Ralph J Mobbs, Justin M Moore, Christopher S Ogilvy, Ajith J Thomas
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.

History

Journal

World neurosurgery

Volume

108

Pagination

850 - 858.e2

Publisher

Elsevier

Location

Amsterdam, The Netherlands

eISSN

1878-8769

Language

eng

Publication classification

C Journal article; C1.1 Refereed article in a scholarly journal

Copyright notice

2017, Elsevier