Comparative Effectiveness of Intravenous Thrombolysis plus Mechanical Thrombectomy versus Mechanical Thrombectomy Alone in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
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

Introduction: The treatment of acute ischemic stroke due to large artery vessel occlusion experienced a dramatic development within the last decade. 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 outcomes were improvement in NIHSS scores and 90-day modified Rankin Scale (mRS) score.

Results: This meta-analysis, which included 2,638 participants from 8 randomized controlled trials, found that BT resulted in a greater improvement in NIHSS scores from baseline compared to endovascular treatment alone (mean difference [MD] 0.96, 95% confidence interval [CI]: [0.73-1.20], p < 0.00001). Additionally, BT group achieved successful recanalization more frequently before and after thrombectomy. Thrombectomy alone hat a shorter time from stroke onset to groin puncture compared to BT (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: BT is superior to endovascular treatment alone based on NIHSS score improvement and successful reperfusion rates before and after thrombectomy. Despite MT alone demonstrating a shorter time from stroke onset to groin puncture (MD of 9.91 min), it did not contribute to greater NIHSS improvement at 24 h and 7 days. Further trials with larger sample sizes are warranted to enhance precision in clinical guidance.

急性缺血性脑卒中静脉溶栓加机械取栓术与单纯机械取栓术的疗效比较:系统回顾与元分析》。
背景:这项荟萃分析研究了桥接疗法(BT)与单纯机械取栓术(MT)治疗急性缺血性脑卒中的有效性:两位独立审查员评估了截至 2024 年 1 月 Scopus、PubMed、Web of Science 和 Cochrane Library 中的双臂临床试验。使用 ROBINS-2 工具对数据提取和质量进行评估。我们的主要结果是NIHSS评分和90天改良Rankin量表(mRS)评分的改善:荟萃分析纳入了 8 项随机对照试验的 2638 名参与者,结果发现,与单纯血管内治疗相比,桥接疗法使 NIHSS 评分从基线得到了更大改善(MD 0.96,95% CI [0.73-1.20],p<0.00001)。此外,桥接疗法组在血栓切除术前后成功再通的次数更多。与桥接疗法相比,单纯血栓切除术从卒中发生到腹股沟穿刺的时间更短(MD 9.91,95% CI [4.31-15.52],p=0.005)。两种治疗方法的功能预后、死亡率、无症状性脑出血发生率以及长期恢复指标(如 Barthel 指数和改良 Rankin 量表评分)相当。结论 根据血栓切除术前和切除术后的 NIHSS 评分改善情况和再灌注成功率,桥接疗法优于单纯血管内治疗。尽管单用 MT 缩短了从卒中发生到腹股沟穿刺的时间(平均差异为 9.91 分钟),但并没有使 24 小时和 7 天后的 NIHSS 改善幅度更大。为提高临床指导的精确性,有必要进一步开展样本量更大的试验。
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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
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.
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