Mechanical thrombectomy combined with Intravenous thrombolysis for acute ischemic stroke: A systematic review and meta-analyses

Abstract

Abstract Purpose To assess the clinical value of mechanical thrombectomy (MT) combined with intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) by comparing it with the direct MT (dMT). Method We conducted a systematic review and meta-analysis involving studies from four databases including PubMed, Embase, WOS, and Cochrane Library. We collected observational studies and randomized controlled studies (RCTs) published from January 2011 to June 2022, providing data about outcomes in terms of functional independence (FI), excellent outcomes (mRS score:0-1), successful recanalization (SR), symptomatic intracerebral hemorrhage (sICH), any intracerebral hemorrhage (aICH), and mortality at three-month or discharge. Results A total of 55 eligible studies (nine RCTs and 46 observational studies) were included. For RCTs, the MT+IVT group was superior in FI (OR:1.27, 95%CI:1.11-1.46), excellent outcomes (OR:1.21, 95%CI:1.03-1.43), SR (OR:1.23, 95%CI:1.05-1.45), mortality (OR:0.72, 95%CI: 0.54-0.97) in crude analyses. In adjusted analyses, the MT+IVT group reduced the risk of mortality (OR:0.65, 95%CI: 0.49-0.88). For observational studies, the results of FI (OR:1.34, 95%CI:1.16-1.33), excellent outcomes (OR:1.30, 95%CI:1.09-1.54), SR (OR:1.23, 95%CI:1.05-1.44), mortality (OR:0.70, 95%CI:0.64-0.77) in the MT+IVT group were better. Additionally, the MT+IVT group increased the risk of hemorrhagic transformation (HT) including sICH (OR:1.16, 95%CI:1.11-1.21) and aICH (OR:1.24, 95%CI:1.05-1.46) in crude analyses. In crude analyses, significant better outcomes were seen in the MT+IVT group on FI (OR:1.36, 95%CI:1.21-1.52), excellent outcomes (OR:1.49, 95%CI:1.26-1.75), and mortality (OR:0.73, 95%CI: 0.56-0.94). Conclusions The MT+IVT therapy did improve the prognosis for AIS patients and did not increase the risk of HT compared with dMT therapy.