Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis
BackgroundSeveral clinical trials have shown that intra-arterial thrombolysis using alteplase during mechanical thrombectomy (MT) has a better outcome than MT alone in ischemic stroke management. We performed the current meta-analysis to estimate the efficacy and safety of MT with intra-arterial alt...
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| Format: | Article |
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Frontiers Media S.A.
2023-07-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2023.1137543/full |
| _version_ | 1797774859599609856 |
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| author | Xingyu Yang Zilan Wang Huiru Chen Youjia Qiu Haiying Teng Zhouqing Chen Zhong Wang Gang Chen |
| author_facet | Xingyu Yang Zilan Wang Huiru Chen Youjia Qiu Haiying Teng Zhouqing Chen Zhong Wang Gang Chen |
| author_sort | Xingyu Yang |
| collection | DOAJ |
| description | BackgroundSeveral clinical trials have shown that intra-arterial thrombolysis using alteplase during mechanical thrombectomy (MT) has a better outcome than MT alone in ischemic stroke management. We performed the current meta-analysis to estimate the efficacy and safety of MT with intra-arterial alteplase therapy.MethodsThe MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched up to Mar. 2022 to identify the clinical trials that compared MT alone versus MT with intra-arterial alteplase therapy. STATA 16.0 was used for statistical analysis. The odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated with a random effect model.ResultsSeven studies involving 1,083 participants were included. The primary outcomes were better functional outcomes, defined as a modified Rankin Scale (mRS) score between 0 and 2 at 90 days, and successful recanalization, defined as a modified thrombolysis in cerebral infarction (mTICI) score ≥ 2b. Compared to MT alone, MT with intra-arterial alteplase did not lead to higher mTICI scores (OR 1.58, 95%CI 0.94 to 2.67, p = 0.085, I2 = 16.8%) but did lead to better mRS (OR 1.37, 95%CI 1.01 to 1.86, p = 0.044). There was no increase in mortality or bleeding events in the overall or subgroup analyses.ConclusionMT with intra-arterial alteplase did not improve the recanalization rate but provided better functional outcomes. The intervention did not increase adverse effects in any subgroup at the same time.Clinical trial registrationhttp://inplasy.com, identifier INPLASY202240027. |
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| issn | 1662-453X |
| language | English |
| last_indexed | 2024-03-12T22:27:22Z |
| publishDate | 2023-07-01 |
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| series | Frontiers in Neuroscience |
| spelling | doaj.art-1884b40311f84a8999e3dedf4b35c3b12023-07-21T21:25:09ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2023-07-011710.3389/fnins.2023.11375431137543Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysisXingyu Yang0Zilan Wang1Huiru Chen2Youjia Qiu3Haiying Teng4Zhouqing Chen5Zhong Wang6Gang Chen7Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaDepartment of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, ChinaBackgroundSeveral clinical trials have shown that intra-arterial thrombolysis using alteplase during mechanical thrombectomy (MT) has a better outcome than MT alone in ischemic stroke management. We performed the current meta-analysis to estimate the efficacy and safety of MT with intra-arterial alteplase therapy.MethodsThe MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched up to Mar. 2022 to identify the clinical trials that compared MT alone versus MT with intra-arterial alteplase therapy. STATA 16.0 was used for statistical analysis. The odds ratios (ORs) and 95% confidence intervals (95%CIs) were calculated with a random effect model.ResultsSeven studies involving 1,083 participants were included. The primary outcomes were better functional outcomes, defined as a modified Rankin Scale (mRS) score between 0 and 2 at 90 days, and successful recanalization, defined as a modified thrombolysis in cerebral infarction (mTICI) score ≥ 2b. Compared to MT alone, MT with intra-arterial alteplase did not lead to higher mTICI scores (OR 1.58, 95%CI 0.94 to 2.67, p = 0.085, I2 = 16.8%) but did lead to better mRS (OR 1.37, 95%CI 1.01 to 1.86, p = 0.044). There was no increase in mortality or bleeding events in the overall or subgroup analyses.ConclusionMT with intra-arterial alteplase did not improve the recanalization rate but provided better functional outcomes. The intervention did not increase adverse effects in any subgroup at the same time.Clinical trial registrationhttp://inplasy.com, identifier INPLASY202240027.https://www.frontiersin.org/articles/10.3389/fnins.2023.1137543/fullintra-arterial thrombolysisalteplasemechanical thrombectomyacute ischemic strokefunctional outcomes after acute stroke |
| spellingShingle | Xingyu Yang Zilan Wang Huiru Chen Youjia Qiu Haiying Teng Zhouqing Chen Zhong Wang Gang Chen Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis Frontiers in Neuroscience intra-arterial thrombolysis alteplase mechanical thrombectomy acute ischemic stroke functional outcomes after acute stroke |
| title | Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis |
| title_full | Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis |
| title_fullStr | Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis |
| title_full_unstemmed | Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis |
| title_short | Mechanical thrombectomy with intra-arterial alteplase provided better functional outcomes for AIS-LVO: a meta-analysis |
| title_sort | mechanical thrombectomy with intra arterial alteplase provided better functional outcomes for ais lvo a meta analysis |
| topic | intra-arterial thrombolysis alteplase mechanical thrombectomy acute ischemic stroke functional outcomes after acute stroke |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2023.1137543/full |
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