Mechanical Thrombectomy and Intravenous Thrombolysis in Patients with Acute Stroke: A Systematic Review and Network Meta-Analysis |
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| Affiliation: | 1. Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan;2. Department of Neurology, Tufts Medical Center, MA, USA;3. Department of Health Services Research, University of Tsukuba, Tsukuba, Japan;4. Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, IA, USA;5. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan;6. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467-2401, USA;1. Service d''Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France;2. CHU de Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France;3. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes F-44093, France;4. Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France;1. Department of Neurosurgery, Nagoya University of Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan;2. Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Japan;3. Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan;4. Department of Medical Technique, Clinical Laboratory, Nagoya University Hospital, Nagoya, Japan;1. Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan;2. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan;3. Department of Artificial Intelligence in Healthcare and Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;4. Social Health Medicine Welfare Laboratory, Public Interest Incorporated Association Kyoto Hokenkai, Kyoto, Japan;1. Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan;2. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan;1. Intensive Care Unit of the Affiliated Huai''an Hospital of Xuzhou Medical University, Huai''an 223001, Jiangsu, China;2. Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, 221004, China;3. Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China;1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119, the South Fourth Ring West Road, Fengtai district, Beijing 100070, China;2. Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, China;3. The George Institute for Global Health at Peking University Health Science Center, Beijing, China;4. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia;5. Department of Ultrasound, Huaian Hospital of Huaian City, Huaian, Jiangsu, China |
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| Abstract: | ObjectivesThe benefit and risk of administration of tissue plasminogen activator (tPA) before endovascular mechanical thrombectomy (E-MT) in acute stroke has been actively debated. We therefore aimed to investigate the efficacy and safety of three therapeutic strategies for acute stroke: direct E-MT, E-MT with pre-administration of tPA, and tPA alone with a network meta-analysis.Materials and methodsPUBMED and EMBASE were searched from September to November 2021 for randomized control trials that compared direct E-MT, E-MT with tPA, and tPA alone therapies in acute stroke. The primary outcome was functional independence, defined as modified Rankin Scale score of 0-2, at 90 days. All-cause mortality, symptomatic intracranial hemorrhage, and successful revascularization were also evaluated.ResultsWe identified 11 randomized controlled trials with a total of 3,640 patients with acute stroke. Compared to E-MT with tPA, direct E-MT provided comparable outcomes regarding functional independence (relative risk (RR): 1.02; 95% confidence interval (CI): 0.88–1.19, I2 = 36.6%) and all-cause mortality (RR: 1.05; 95% CI: 0.85–1.31, I2 = 0%). The incidence of symptomatic intracranial hemorrhage was not significantly different between direct E-MT and E-MT with tPA (RR: 0.83; 95% CI: 0.57–1.20, I2 = 0%). Direct E-MT had favorable functional independence (RR: 1.41; 95% CI: 1.15-1.74, I2 = 36.6%) and higher successful revascularization rate (RR: 1.60; 95% CI: 1.33–1.93, I2 = 61.2%) than tPA alone.ConclusionsDirect E-MT alone led to acceptable outcomes even in comparison to E-MT with tPA, whereas additional tPA did not cause higher risk of symptomatic intracranial hemorrhage. |
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