Author:
Bao Qiangji,Huang Xiaodong,Wu Xinting,Huang Hao,Zhang Xiaoqiang,Yang Mingfei
Abstract
Abstract
Background
Intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) is the standard treatment for patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). However, the efficacy and safety of IVT before EVT in AIS-LVO patients with atrial fibrillation (AF) remains controversial. Thus, this study aims to assess the benefit of IVT plus EVT and direct EVT alone in AIS-LVO patients with AF.
Method
Relevant studies that evaluated the outcomes of IVT plus EVT versus direct EVT alone in AIS-LVO patients with AF were systematically searched in PubMed, Embase, and Cochrane Library from inception to August 10, 2023. The outcomes included successful reperfusion (score of 2b to 3 for thrombolysis in cerebral infarction), symptomatic intracerebral hemorrhage (sICH), good clinical outcome (modified Rankin scale score ≤ 2) at 3 months, and 3-month mortality.
Result
Eight eligible observational studies involving 6998 (3827 in the IVT plus EVT group and 3171 in the direct EVT group) patients with AIS-LVO complicated by AF were included. Compared with direct EVT, IVT plus EVT resulted in better 3-month clinical outcomes (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.05–1.54) and lower 3-month mortality (OR 0.78, 95% CI 0.68–0.88). However, the incidence of sICH (OR 1.26, 95% CI 0.91–1.75) and the rate of successful reperfusion (OR 0.98, 95% CI 0.83–1.17) were not significantly different between treatment modalities.
Conclusion
IVT plus EVT leads to better functional outcomes and lower mortality in AIS-LVO patients with AF. Withholding IVT plus EVT from patients with AF alone may not be justified.
Funder
Guang 'an Science and Technology Bureau
Kunlun Talents of Qinghai Province•High-end Innovation and Entrepreneurship Talent Project-Cultivate leading talents.
Publisher
Springer Science and Business Media LLC