Literature Review

Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: A meta-analysis

Selected in Stroke by RIVERA Rodrigo

Authors: Mistry EA, Mistry AM, Nakawah MO, Chitale RV, James RF, Volpi JJ, Fusco MR

Reference: Stroke. 2017;STROKEAHA.117.017320

Published: July 2017

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Friday 04 August 2017
Rodrigo RIVERA

Mechanical thrombectomy has become one of the main activities in many endovascular centres around the world. Several studies have shown that IV rTPA/Alteplase administration could delay the endovascular process for thrombectomy in large vessel occlusion strokes.

In this paper, the authors performed a Meta-Analysis to define if IV thrombolsysis (IVT) previous to mechanical thrombectomy (MT) is beneficial in this group of patients. Thirteen studies were included in this revision after selection, with randomised and non-randomised ones.

Results were clearly in favour of MT+ IVT vs MT alone, with better outcome at 3 months, higher success of recanalisation and lesser device passes. Moreover, lower mortality and no increase in ICH.

Despite the results, they should be taken with some precautions, because MT patients were not randomized to IV or controlled. Patients from the MT group were normally assigned because of anticoagulant therapy or delayed presentation, so this could be a reason by itself for worse outcomes.

Data from this Meta-Analysis is in accordance to several guidelines including the one from the AHA (reviewed in 2015). Thus, because of the nature of eligible studies for this analysis, a randomised trial, matching groups of MT with or without IV treatment is needed in the future to clear this point. 

 

Rodrigo Rivera, MD
Neuroradiology Department
Instituto de Neurocirugia Dr. Asenjo
Santiago, Chile

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