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Title: Endovascular Thrombectomy Alone versus Combined with Intravenous Thrombolysis.
Austin Authors: Phan, Kevin;Dmytriw, Adam A;Maingard, Julian;Asadi, Hamed ;Griessenauer, Christoph J;Ng, Wyatt;Kewagamang, Kitso;Mobbs, Ralph J;Moore, Justin M;Ogilvy, Christopher S;Thomas, Ajith J
Affiliation: NeuroSpine Surgery Research Group, Sydney, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Australia
Issue Date: Dec-2017
Date: 2017-08-18
Publication information: World Neurosurgery 2017; 108: 850-858.e2
Abstract: BACKGROUND: To date, no randomized trial has directly addressed the question of whether intravenous (IV) tissue plasminogen activator (tPA) improves outcomes in IV tPA-eligible patients who will eventually undergo endovascular therapy (EVT), or whether a direct EVT strategy is equally effective. We performed a systematic review and meta-analysis to compare the efficacy and safety of direct EVT versus endovascular treatment with IV tPA (EVT+IV tPA) in adults with acute ischemic stroke. METHODS: We performed electronic searches of 6 databases from their inception to January 2017. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Twelve comparative studies, comprising 1275 patients in the EVT-only arm and 1340 patients in the combined EVT+IV tPA arm, were included. The rates of good functional outcomes (modified Rankin Scale score ≤2) and 90-day mortality were not statistically significantly different between the EVT and EVT+IV tPA arms (44% vs. 48%; odds ratio [OR], 0.80; 95% confidence interval [CI], 0.64-1.002; P = 0.052 and 20.4% vs. 19.4%, OR 1.19; 95% CI, 0.83-1.71; P = 0.34, respectively). The rate of symptomatic intracranial hemorrhage also was not significantly different between the EVT and EVT+IV tPA arms (3.7% vs. 3.8%; OR, 0.98; 95% CI, 0.65-1.48; P = 0.91). There were no between-group differences in the rates of other complications. CONCLUSIONS: No significant differences between the 2 groups were found in terms of favorable functional outcome, mortality rate, or complications based on contemporary endovascular therapies.
DOI: 10.1016/j.wneu.2017.08.040
ORCID: 0000-0001-8958-2411
Journal: World Neurosurgery
PubMed URL: 28823660
Type: Journal Article
Subjects: Acute ischemic Stroke
Stent retriever
Tissue plasminogen activator
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