Direct mechanical thrombectomy with or without thrombolysis for acute ischemic stroke

Abstract

The efficacy of direct mechanical thrombectomy (MT) and thrombectomy combined with intravenous thrombolysis (MT+IVT) in patients with acute ischemic stroke is still unclear. To comprehensively analyze the two strategies, we conducted a meta-analysis of randomized controlled trials (RCTs). Six RCTs were recruited from Ovid Medline, Embase, and Cochrane Central Register of Controlled Trials and published from 2020 to 2023, including 1164 in the MT group and 1170 in the MT + IVT group. There was no significant difference between the MT group and MT+IVT group in 90-day favorable outcome (OR 0.93, 95% CI 0.79-1.09, P=0.37, I2=0%,) and excellent outcome (OR 0.98, 95% CI 0.82-1.18, P=0.82, I2=0%). Similarly, there was no significant difference in 90-day mortality (OR 1.08, 95% CI 0.86-1.35, P=0.52, I2=0%) and symptomatic intracranial hemorrhage (OR 0.82, 95% CI 0.57-1.19, P=0.30, I2=0%). However, the successful recanalization rate of the MT group was significantly lower than that of the MT+IVT group (OR 0.73, 95% CI 0.57-0.94, P=0.01, I2=0%). There was no significant difference in functional outcome and safety endpoints between direct MT and MT+IVT, but the successful recanalization rate of MT+IVT was higher.