Abstract 12907: Endovascular Mechanical Thrombectomy And Intravenous Alteplase In Patients Acute Stroke: A Network Meta-analysis Of Randomized Controlled Trials

Abstract

Background: The benefit and risk of administration of intravenous alteplase (IA) before endovascular mechanical thrombectomy (EMT) in acute stroke is actively debated. Objectives: We aimed to investigate the efficacy and safety of direct EMT compared to EMT with pre-administration of IA and IA alone with a network meta-analysis. Methods: PUBMED and EMBASE were searched through April 2021 for randomized control trials (RCTs) investigating the efficacy and safety of the treatment with direct EMT or EMT with IA or IA in patients with acute stroke caused by anterior large vessel occlusion. The primary outcome was functional independence evaluated by the modified Rankin Scale (mRS) score of 0 to 2 at 90 days from the onset of symptoms. The secondary outcomes were successful recanalization within 72 hours all-cause mortality at 90 days and symptomatic intracranial hemorrhage within 7 days. Results: We identified 11 RCTs with a total of 3,640 patients with acute stroke. Compared to EMT with IA, direct EMT had similar effects on achieving the primary outcome (relative risk (RR): 1.02; 95% confidence interval (CI): 0.88-1.19, P=0.12, I 2 =36.6%) (Figure 1A) and successful recanalization within 72 hours (RR: 0.95; 95% CI: 0.85-1.07, P=0.04, I 2 =61.2%) and had similar risk of all-cause mortality (RR: 1.05; 95% CI: 0.85-1.31, P=0.69, I 2 =0%) and symptomatic intracranial hemorrhage within 7 days (RR: 0.83; 95% CI: 0.57-1.20, P=0.96, I 2 =0%). In addition, direct MT had higher proportions in the primary outcome (RR: 1.41; 95% CI: 1.15-1.74) (Figure 1B) and successful revascularization (RR: 1.63; 95% CI: 1.32-2.01) than IA alone therapy. Conclusions: The current study suggested that direct EMT therapy provided acceptable outcomes even in comparison to EMT with IA. Further RCTs are warranted to identify the specific population requiring the administration of IA before EMT compared to direct EMT.