Meta-analysis of the efficacy and safety of combined arterial and venous thrombolysis in the treatment of acute ischemic stroke.

Objective: This study aims to evaluate the efficacy and safety of combined arterial and venous thrombolysis in the treatment of acute ischemic stroke.

Methods: Randomized controlled trials (RCTs) were systematically evaluated by comprehensive literature review and inclusion criteria. Cochrane bias risk assessment tool was used to evaluate the research quality, and RevMan 5.3 software was used for Meta-analysis. The main outcome indicators included NIHSS, MRS, recanalization rate, cerebral hemorrhage and mortality.

Results: 20 articles were finally included, including 2287 subjects, including 1096 cases in the combined group and 1191 cases in the control group, all of which were randomized controlled experiments. The improvement of NIHSS score in combined thrombolysis group was better than that in control group (OR = 1.79, p < 0.001). The improvement of mRS score in the combined thrombolysis group was better than that in the control group (OR = 1.54, p < 0.01). The recanalization rate of artery and vein combined with thrombolysis was better (OR = 2.91, p < 0.01). There was no significant difference in the risk of symptomatic cerebral hemorrhage after thrombolysis between the two groups (p > 0.05). The combined thrombolysis group had a better risk of death after thrombolysis (OR = 0.53, p < 0.01).

Conclusion: Arteriovenous thrombolysis combined with acute cerebral infarction has advantages in NIHSS, MRS and recanalization rate. However, there was no significant increase in arterial or intravenous thrombolysis for symptomatic cerebral hemorrhage. Arteriovenous combined thrombolysis may have curative effect and acceptable safety in acute ischemic stroke.