Direct endovascular treatment versus bridging therapy in patients with acute ischemic stroke eligible for intravenous thrombolysis: systematic review and meta-analysis
| Autor: | Xuhui Deng, Deyan Kong, Jian Tang, Yiju Xie, Jian Zhang, Shijian Chen, Zhijian Liang, Jinglian Luo, Yueling Zhang, Shengliang Shi |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment MEDLINE Cochrane Library Lower risk Brain Ischemia law.invention Fibrinolytic Agents Randomized controlled trial Modified Rankin Scale law medicine Humans Thrombolytic Therapy Ischemic Stroke Thrombectomy business.industry Endovascular Procedures General Medicine Thrombolysis Surgery Stroke Treatment Outcome Meta-analysis Observational study Neurology (clinical) business |
| Zdroj: | Journal of NeuroInterventional Surgery. 14:321-325 |
| ISSN: | 1759-8486 1759-8478 |
| DOI: | 10.1136/neurintsurg-2021-017928 |
| Popis: | ObjectiveIn this review and meta-analysis we sought to compare the efficacy and safety of direct endovascular thrombectomy (EVT) and bridging therapy for intravenous thrombolysis (IVT)-eligible patients with acute ischemic stroke caused by large vessel occlusions (AIS-LVO).MethodsWe searched Medline, Embase, and the Cochrane Library for published randomized clinical trials (RCTs) and observational studies providing outcomes of patients with IVT-eligible AIS-LVO who have undergone EVT with or without IVT. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 0–2 at 90 days. The secondary outcomes included the rates of (1) an excellent outcome defined as an mRS score of 0 or 1 at 90 days, (2) mortality at 90 days, (3) symptomatic intracranial hemorrhage (sICH), (4) any type of intracranial hemorrhage (ICH), (5) successful recanalization, and (6) clot migration.ResultsWe included three RCTs and six observational studies (4 of which were propensity score-adjusted studies) with a total of 3133 patients. In unadjusted and adjusted analyses, no differences in the rates of mRS scores 0–2, mRS scores 0–1, mortality at 90 days, sICH or successful recanalization were detected between patients with AIS-LVO who underwent direct EVT or bridging therapy. The patients treated with direct EVT had a lower risk ratio for any type of ICH and clot migration than did the patients treated with bridging therapy.ConclusionCompared with bridging therapy, direct EVT may be equally effective and yield a lower rate of ICH and clot migration in patients with AIS.Trail registration numberPROSPERO: CRD42021236691. |
| Databáze: | OpenAIRE |
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