Background

Recently, several randomized controlled trials (RCTs) about direct mechanical thrombectomy (d-MT) vs. intravenous thrombolysis before MT (IVT + MT) for acute ischemic stroke (AIS) patients have been reported. This study aims to investigate the differences in efficacy and safety of MT with or without IVT for the treatment of patients with AIS.

Methods

MEDLINE, EMBASE, Cochrane Library and Clinicaltrials.gov from March 2011 to February 2021 were systematically searched for studies comparing the two strategies directly. Review Manager 5.3 software was used to assess the risk of bias and pool the data with a random effect model.

Results

We pooled 1633 patients from 4 RCTs. The primary outcome, proportion of patients achieving functional independence (mRS0-2) at 90 days, was not significantly different between the two groups (MT 46.02% vs. IVT + MT 45.47%, OR 1.02; 95% CI 0.84–1.25). However, the risk of developing any ICH was lower in the d-MT group (RR 0.75; 95% CI 0.63–0.89). In addition, the remaining secondary outcomes, such as successful reperfusion (eTICI scale, 2b-3) at final angiogram (OR 0.80; 95% CI, 0.62–1.03) and mortality at 90 days (RR 1.06; 95% CI 0.85–1.31), did not differ between the groups.

Conclusions

Outcomes were similar for d-MT and IVT + MT, with d-MT having a lower risk of any ICH. We need to focus on precision medicine in the future.

Registration

URL: http://inplasy.com; Unique identifier: INPLASY202130094.

中文翻译：

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急性缺血性卒中患者血栓切除术联合或不联合溶栓：系统评价和荟萃分析

背景

最近，已经报道了几项关于急性缺血性卒中 (AIS) 患者直接机械取栓 (d-MT) 与 MT 前静脉溶栓 (IVT + MT) 的随机对照试验 (RCT)。本研究旨在探讨 MT 联合或不联合 IVT 治疗 AIS 患者的疗效和安全性差异。

方法

系统检索了 2011 年 3 月至 2021 年 2 月期间的 MEDLINE、EMBASE、Cochrane Library 和 Clinicaltrials.gov，以寻找直接比较这两种策略的研究。Review Manager 5.3 软件用于评估偏倚风险并将数据与随机效应模型合并。

结果

我们汇集了来自 4 个 RCT 的 1633 名患者。主要结果，即在 90 天时实现功能独立 (mRS0-2) 的患者比例，两组之间没有显着差异（MT 46.02% vs. IVT + MT 45.47%，OR 1.02；95% CI 0.84–1.25）。然而，d-MT 组发生任何 ICH 的风险较低（RR 0.75；95% CI 0.63–0.89）。此外，剩余的次要结局，如最终血管造影时成功再灌注（eTICI 量表，2b-3）（OR 0.80；95% CI，0.62-1.03）和 90 天死亡率（RR 1.06；95% CI 0.85-1.31） )，各组之间没有差异。

结论

d-MT 和 IVT + MT 的结果相似，d-MT 发生任何 ICH 的风险较低。未来我们需要专注于精准医疗。

登记

网址：http://inplasy.com；唯一标识符：INPLASY202130094。