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Background <p>Endovascular thrombectomy (EVT) is the gold standard for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). A few trials studied EVT in AIS-LVO with large ischemic infarcts. We investigated the impact of intravenous thrombolysis (IVT) on EVT outcomes in those patients.</p> Methods <p>We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane Handbook of Systematic Reviews and Interventions. We searched 4 databases and performed our analysis utilizing a pooled risk ratio (RR) with a 95% confidence interval (CI).</p> Results <p>Three studies investigated EVT with and without IVT in AIS-LVO patients with large ischemic infarcts. Regarding the modified Rankin Scale (mRS) score of 0–2 at 3 months, there was a statistically significant difference favoring EVT plus IVT (RR: 1.48, 95%CI: 1.27, 1.72, <i>P</i> &lt; 0.00001). In respect of mRS score of 0–3, the analysis also favored EVT plus IVT (RR: 1.25, 95%CI: 1.11, 1.41, <i>P</i> = 0.0003). Regarding early neurological improvement (ENI) at 24 and 36&#xa0;hours, our analysis favored EVT plus IVT (RR: 1.16, 95%CI: 1.01, 1.34, <i>P</i> = 0.03). In terms of mortality, our analysis favored EVT plus IVT (RR: 0.88, 95%CI: 0.77, 1, <i>P</i> = 0.04). There was no difference between the two groups across different types of intracranial hemorrhage (ICH).</p> Conclusion <p>Our results showed a beneficial impact of IVT on the outcomes of EVT in AIS-LVO patients with large ischemic infarcts in terms of functional outcomes and ENI. IVT was also associated with a lower mortality rate but not with an increased risk of ICH. Larger studies are needed to corroborate such results.</p>

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Endovascular thrombectomy plus intravenous thrombolysis versus endovascular thrombectomy alone for large ischemic stroke

  • 期刊论文

  • 发表日期：

    2025年5月22日

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  • Mohamed Elfil,
  • Abdallah Abbas,
  • Hayes Fountain,
  • Ebrahem Salah Abdul-Hamid,
  • Mohammad Aladawi,
  • Zaid Najdawi,
  • Ahmed Elmashad,
  • Hazem S. Ghaith,
  • Giana Dawod,
  • Iman Moeini-Naghani,
  • Suhail Abdulla AlRukn,
  • Chaitanya Medicherla,
  • Hosam Aljehani,
  • Priyank Khandelwal,
  • Gurmeen Kaur,
  • Mohammad El-Ghanem,
  • Chirag D. Gandhi,
  • Fawaz Al-Mufti

摘要

Background

Endovascular thrombectomy (EVT) is the gold standard for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). A few trials studied EVT in AIS-LVO with large ischemic infarcts. We investigated the impact of intravenous thrombolysis (IVT) on EVT outcomes in those patients.

Methods

We conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane Handbook of Systematic Reviews and Interventions. We searched 4 databases and performed our analysis utilizing a pooled risk ratio (RR) with a 95% confidence interval (CI).

Results

Three studies investigated EVT with and without IVT in AIS-LVO patients with large ischemic infarcts. Regarding the modified Rankin Scale (mRS) score of 0–2 at 3 months, there was a statistically significant difference favoring EVT plus IVT (RR: 1.48, 95%CI: 1.27, 1.72, P < 0.00001). In respect of mRS score of 0–3, the analysis also favored EVT plus IVT (RR: 1.25, 95%CI: 1.11, 1.41, P = 0.0003). Regarding early neurological improvement (ENI) at 24 and 36 hours, our analysis favored EVT plus IVT (RR: 1.16, 95%CI: 1.01, 1.34, P = 0.03). In terms of mortality, our analysis favored EVT plus IVT (RR: 0.88, 95%CI: 0.77, 1, P = 0.04). There was no difference between the two groups across different types of intracranial hemorrhage (ICH).

Conclusion

Our results showed a beneficial impact of IVT on the outcomes of EVT in AIS-LVO patients with large ischemic infarcts in terms of functional outcomes and ENI. IVT was also associated with a lower mortality rate but not with an increased risk of ICH. Larger studies are needed to corroborate such results.