Background and Purpose:The optimal recanalization strategy for acute ischemic stroke with large vessel occlusion continues to be an area of active interest. Network meta-analysis can provide insight when direct comparative evidence is lacking.Methods:A systematic review of the literature using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and SinoMed was performed, and a search was conducted for clinical trials on ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and StrokeCenter.org. Four independent reviewers conducted the study selection, data abstraction, and quality assessments.Results:The literature review identified 17 trials including 3236 patients and 8 ongoing clinical trials. Sample sizes ranged from 7 to 656 participants. Intravenous thrombolysis (IVT) was the most common intervention, followed by IVT plus mechanical thrombectomy (MT), IVT plus intraarterial thrombolysis, intraarterial thrombolysis alone, and MT alone. In the pooled network meta-analysis, IVT+MT was associated with a higher rate of independent functioning. In contrast, IVT was ranked as the most ineffective treatment strategy with respect to neurological functions, while direct MT was ranked as the least safe intervention with respect to all-cause mortality. Also, irrespective of assessment tools, endovascular treatment plus IVT led to higher successful recanalization rate than thrombolysis alone.Conclusions:Compared with other recanalization treatments, IVT+MT seems to be the most effective strategy, without increasing detrimental effects, for thrombolysis-eligible patients with large vessel occlusion-acute ischemic stroke. To improve the current evidentiary basis for recanalization treatment, future trials and real-world studies are warranted and should use unified definitions of symptomatic intracranial hemorrhage and recanalization.

中文翻译：

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大血管闭塞性急性缺血性中风再通疗法的疗效和安全性：系统评价。

背景与目的：对于具有大血管闭塞的急性缺血性中风的最佳再通策略仍然是人们关注的领域。方法：使用PubMed，Embase，Cochrane对照试验中央注册系统和SinoMed对文献进行系统的综述，并进行临床试验的临床试验检索。 .gov，世界卫生组织国际临床试验注册平台和StrokeCenter.org。结果：文献综述确定了17项试验，包括3236例患者和8项正在进行的临床试验，由4名独立审稿人进行了研究选择，数据抽象和质量评估。样本数量从7到656名参与者不等。静脉溶栓（IVT）是最常见的干预措施，其次是IVT加机械血栓切除术（MT），IVT加动脉内溶栓，仅动脉内溶栓和仅MT。在合并网络的荟萃分析中，IVT + MT与较高的独立功能率相关。相反，就神经功能而言，IVT被认为是最无效的治疗策略，而就全因死亡率而言，直接MT被认为是最不安全的干预措施。此外，无论使用哪种评估工具，血管内治疗加IVT均比单独的溶栓术具有更高的成功再通率。结论：与其他再通治疗相比，IVT + MT似乎是最有效的策略，并且不会增加有害影响，适用于有溶栓作用的大血管闭塞急性缺血性卒中患者。为了改善目前的再通治疗的证据基础，有必要进行进一步的试验和实际研究，并应使用有症状的颅内出血和再通的统一定义。