Thrombectomy with or without thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis.
Ischemia
Meta-analysis
Stroke
Thrombectomy
Thrombolysis
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
05
06
2021
accepted:
06
09
2021
revised:
06
09
2021
pubmed:
15
9
2021
medline:
25
3
2022
entrez:
14
9
2021
Statut:
ppublish
Résumé
Recently, several randomized controlled trials (RCTs) about direct mechanical thrombectomy (d-MT) vs. intravenous thrombolysis before MT (IVT + MT) for acute ischemic stroke (AIS) patients have been reported. This study aims to investigate the differences in efficacy and safety of MT with or without IVT for the treatment of patients with AIS. MEDLINE, EMBASE, Cochrane Library and Clinicaltrials.gov from March 2011 to February 2021 were systematically searched for studies comparing the two strategies directly. Review Manager 5.3 software was used to assess the risk of bias and pool the data with a random effect model. We pooled 1633 patients from 4 RCTs. The primary outcome, proportion of patients achieving functional independence (mRS0-2) at 90 days, was not significantly different between the two groups (MT 46.02% vs. IVT + MT 45.47%, OR 1.02; 95% CI 0.84-1.25). However, the risk of developing any ICH was lower in the d-MT group (RR 0.75; 95% CI 0.63-0.89). In addition, the remaining secondary outcomes, such as successful reperfusion (eTICI scale, 2b-3) at final angiogram (OR 0.80; 95% CI, 0.62-1.03) and mortality at 90 days (RR 1.06; 95% CI 0.85-1.31), did not differ between the groups. Outcomes were similar for d-MT and IVT + MT, with d-MT having a lower risk of any ICH. We need to focus on precision medicine in the future. URL: http://inplasy.com ; Unique identifier: INPLASY202130094.
Sections du résumé
BACKGROUND
BACKGROUND
Recently, several randomized controlled trials (RCTs) about direct mechanical thrombectomy (d-MT) vs. intravenous thrombolysis before MT (IVT + MT) for acute ischemic stroke (AIS) patients have been reported. This study aims to investigate the differences in efficacy and safety of MT with or without IVT for the treatment of patients with AIS.
METHODS
METHODS
MEDLINE, EMBASE, Cochrane Library and Clinicaltrials.gov from March 2011 to February 2021 were systematically searched for studies comparing the two strategies directly. Review Manager 5.3 software was used to assess the risk of bias and pool the data with a random effect model.
RESULTS
RESULTS
We pooled 1633 patients from 4 RCTs. The primary outcome, proportion of patients achieving functional independence (mRS0-2) at 90 days, was not significantly different between the two groups (MT 46.02% vs. IVT + MT 45.47%, OR 1.02; 95% CI 0.84-1.25). However, the risk of developing any ICH was lower in the d-MT group (RR 0.75; 95% CI 0.63-0.89). In addition, the remaining secondary outcomes, such as successful reperfusion (eTICI scale, 2b-3) at final angiogram (OR 0.80; 95% CI, 0.62-1.03) and mortality at 90 days (RR 1.06; 95% CI 0.85-1.31), did not differ between the groups.
CONCLUSIONS
CONCLUSIONS
Outcomes were similar for d-MT and IVT + MT, with d-MT having a lower risk of any ICH. We need to focus on precision medicine in the future.
REGISTRATION
BACKGROUND
URL: http://inplasy.com ; Unique identifier: INPLASY202130094.
Identifiants
pubmed: 34519851
doi: 10.1007/s00415-021-10798-x
pii: 10.1007/s00415-021-10798-x
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1809-1816Subventions
Organisme : Suzhou Health Talents Training Project
ID : GSWS2019002
Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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