Efficacy and safety of intra-arterial thrombolysis after endovascular reperfusion for acute ischemic stroke: a systematic review and meta-analysis of randomized trials.
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引用次数: 0
Abstract
Objective: This pooled analysis aims to evaluate the efficacy and safety of intra-arterial thrombolysis (IAT) following near-complete to complete reperfusion by endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).
Methods: We conducted a search of PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) investigating the adjunct benefit of IAT in patients with AIS-LVO who had achieved a score on the Thrombolysis In Cerebral Infarction (TICI) scale of 2b-3 after EVT. Efficacy outcomes encompassed excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days, and functional independence (mRS 0-2). Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. A network meta-analysis (NMA) was performed to evaluate the effects of different types of intra-arterial thrombolytic agents on mRS 0-1.
Results: A total of 7 RCTs were included in the analysis, involving 2,128 patients. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects model. The pooled results indicated that adjunctive IAT did not significantly improve the rate of functional independence (RR 1.04, 95% CI 0.96-1.13, P = 0.29). However, there was a significant increase in excellent functional outcome with adjunctive IAT (RR 1.23, 95% CI 1.11-1.36, P < 0.001). The pooled analysis did not demonstrate any differences between EVT + IAT and EVT only in rates of sICH (RR 1.23, 95% CI 0.81-1.85, P = 0.33) or 90-day mortality (RR: 0.98, 95% CI: 0.82-1.18; P = 0.86). The NMA found no significant difference in achieving mRS 0-1 among arterial adjunctive alteplase, tenecteplase, and urokinase following successful reperfusion.
Conclusions: IAT as an adjunct to successful EVT appears to enhance excellent functional outcome in patients with AIS-LVO without a significant increase in sICH and mortality.
期刊介绍：
The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.
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