Abstract TP142: Intravenous Thrombolysis In Combination With Mechanical Thrombectomy: An Updated Meta-Analysis Of Clinical Trials

Abstract

Introduction: Mechanical thrombectomy (MT) is the gold standard for large vessel occlusion (LVO) strokes. The current guidelines state that LVO patients who are eligible for intravenous thrombolysis (IVT) and MT should receive both treatments. However, a few trials investigated the benefits and safety of combining MT with IVT. We conducted this meta-analysis to provide collective evidence on the efficacy and safety of IVT+MT, and to estimate the risk of complications of this approach as compared to MT alone. Methods: We performed a comprehensive literature search of 4 databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL). For outcomes with continuous data, the mean difference (MD) between both groups from the baseline to the endpoint, with its standard deviation (SD), were pooled in the DerSimonian-Laird (DL) random-effect model. For studies reporting data in multiple time points, we considered the last endpoint for the primary analysis. For outcomes with dichotomous data, the frequency of events and the total number of patients in each group were pooled as relative risk (RR) between both groups in the DL random-effect model. All statistical analyses were done by RevMan. Results: 7 clinical trials were included in the meta-analysis with a total of 2,317 patients. There were no significant differences between both groups in terms of functional independence (90-day mRS score 0-2: RR 1.03, 95% CI [0.90 to 1.19], P=0.65), successful recanalization (TICI score ≥2b: RR 1.04, 95% CI [0.92 to 1.17], P=0.53), complete recanalization (TICI score 3: RR 1.06, 95% CI [0.86 to 1.30], P=0.60), or mortality (RR 0.94, 95% CI [0.76 to 1.18], P=0.61). Regarding complications, there were no significant differences between both groups in terms of symptomatic intracranial hemorrhage (RR 0.94, 95% CI [0.74 to 1.20], P=0.64), or any intracranial hemorrhage (RR 1.12, 95% CI [0.94 to 1.34], P=0.57). Conclusion: Our results did not favor either IVT+MT or MT alone in terms of clinical outcomes and complications. However, more trials are needed to further compare both approaches and to evaluate the impact of certain factors on this comparison such as MT technique (Stent Retriever versus Aspiration), LVO location, and the used thrombolytic agent (Alteplase versus Tenecteplase).