Comparative Effectiveness of Intravenous Thrombolysis plus Mechanical Thrombectomy versus Mechanical Thrombectomy Alone in Acute Ischaemic Stroke: A systematic review and Meta-Analysis.
Ali Hammed, Almonzer Al-Qiami, Ahmad Alzawahreh, Josef Rosenbauer, Eman Ayman Nada, Zina Otmani, Nada G Hamam, Asmaa Zakria Alnajjar, Elsayed Mohamed Hammad, Rawan Hamamreh, Karel Kostev, Gregor Richter, Christian Tanislav
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Abstract
Background: This meta-analysis investigates the effectiveness of Bridging Therapy (BT) versus mechanical thrombectomy (MT) alone in treating acute ischemic stroke.
Methods: Two independent reviewers assessed two-arm clinical trials from Scopus, PubMed, Web of Science, and the Cochrane Library up to January 2024. Data extraction and quality were evaluated using the ROBINS-2 tool. Our primary outcome were improvement in NIHSS scores and 90-day modified Rankin Scale (mRS) score.
Results: The meta-analysis, which included 2,638 participants from 8 randomized controlled trials, found that Bridging therapy resulted in a greater improvement in NIHSS scores from baseline compared to endovascular treatment alone (MD 0.96, 95% CI [0.73-1.20], p<0.00001). Additionally, Bridging therapy group achieved successful recanalization more frequently before and after thrombectomy Thrombectomy alone hat a shorter time from stroke onset to groin puncture compared to bridging therapy (MD 9.91, 95% CI [4.31-15.52], p=0.005). Functional outcomes, mortality rates, symptomatic intracerebral hemorrhage rates, and long-term recovery metrics, such as Barthel Index and modified Rankin Scale scores, were comparable between both treatment approaches. Conclusion Bridging therapy is superior to endovascular treatment alone based on NIHSS score improvement and successful reperfusion rates before und after thrombectomy. Despite MT alone demonstrating a shorter time from stroke onset to groin puncture (mean difference of 9.91 minutes), it did not contribute to greater NIHSS improvement at 24 hours and 7 days. Further trials with larger sample sizes are warranted to enhance precision in clinical guidance.
期刊介绍:
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.