Abstract 13065: Comparative Efficacy of Endovascular Mechanical Thrombectomy With and Without Intravenous Thrombolysis in Acute Ischemic Stroke: A Meta-Analysis of Randomized Trials

Abstract

Background: Current guidelines states that intravenous tissue plasminogen activator (tPA) should be administered to eligible acute ischemic stroke (AIS) patients even if endovascular mechanical thrombectomy (EMT) is being considered. However, there is still uncertainty regarding the superiority of EMT with tPA over direct EMT. Aim: This meta-analysis seeks to provide a comprehensive evaluation of the comparative effectiveness of EMT with and without tPA in treating AIS. Methods: We performed a systematic literature search using PubMed, EMBASE, Cochrane, Web of Science, and clincialtrials.gov. Relevant articles from inception until April 10th, 2023, were scrutinized. The primary outcome of interest was functional independence assessed by the modified Rankin Score between 0-2 at 90 days. Secondary outcomes included all-cause mortality within 90 days, successful recanalization defined as extended thrombolysis in cerebral infarction score of 2b to 3, and safety outcome, i.e., the occurrence of symptomatic intracranial hemorrhage (sICH). Results: Our analysis included 6 RCTs involving 2334 patients. The pooled analysis of the primary outcome revealed no significant difference between EMT with tPA and direct EMT [OR, 1.08 (95% CI, 0.87-1.34), p=0.41]. All-cause mortality [OR, 0.93 (95% CI, 0.74-1.16), p=0.42] and sICH [OR, 1.22 (95% CI, 0.91-1.62), p=0.14] also did not significantly differ between the two groups. However, the results for successful recanalization [OR, 1.35 (95% CI, 1.01-1.80), p=0.04] indicate that patients who underwent EMT with tPA had a 35% significantly higher likelihood of achieving successful recanalization. Conclusion: Our meta-analysis found no significant difference in functional outcome, all-cause mortality, or sICH between EMT with tPA and direct EMT. However, EMT with tPA was associated with a higher likelihood of successful recanalization, suggesting its potential benefit in improving recanalization rates in AIS.