Intravenous versus intra-arterial thrombolysis in ischemic stroke: a systematic review and meta-analysis.

Qing-Feng Ma,Chang-Biao Chu,Hai-Qing Song,Jens Minnerup

doi:10.1371/journal.pone.0116120

Qing-Feng Ma, Chang-Biao Chu + Show 2 more

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https://doi.org/10.1371/journal.pone.0116120

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Journal: PloS one	Publication Date: Jan 8, 2015
Citations: 17	License type: CC BY 4.0

Affiliation: Xuan Wu Hospital of the Capital Medical University

Abstract

BackgroundReperfusion following ischemic stroke can be attained by either intravenous thrombolysis (IVT) or intra-arterial thrombolysis (IAT). Only a limited number of randomized prospective studies have compared the efficacy and safety of IVT and IAT. This meta-analysis investigated possible clinical benefits of IAT relative to IVT in patients with acute ischemic stroke.MethodsWe searched the PubMed, Cochrane, and Google Scholar databases through October 2013 for manuscripts that describe the findings of randomized controlled or prospective studies that evaluated the outcomes of patients with ischemic stroke who were treated with IVT or IAT. The clinical outcome measures were score on the modified Rankin scale (mRS) and mortality at 90 days. A favorable outcome was defined as an mRS score of 0 to 2.ResultsFor the mRS, the combined odds ratio (OR) of 3.28 (95% confidence interval (CI), 1.91 to 5.65, P < 0.001) indicated that patients who received IAT had a significantly higher chance for a favorable outcome than did those who received IVT. For mortality, the OR indicated that IAT therapy significantly reduced the proportion of patients who died within 90 days of the procedure (combined OR, 0.40; 95%CI, 0.17 to 0.92; P = 0.032).ConclusionThis meta-analysis determined that IAT conferred a significantly greater probability of achieving a favorable outcome compared with IVT. There was also a significant difference in mortality rates between IAT and IVT. The studies included in this analysis were small and heterogeneous; therefore, larger randomized prospective clinical studies are necessary to further investigate this issue.

Highlights

Treatment of acute ischemic stroke attempts to open the occluded blood vessels in order to reestablish blood flow and to improve outcomes [1]
The odds ratio (OR) indicated that intra-arterial thrombolysis (IAT) therapy significantly reduced the proportion of patients who died within 90 days of the procedure
This meta-analysis determined that IAT conferred a significantly greater probability of achieving a favorable outcome compared with intravenous thrombolysis (IVT)

Summary

Introduction

Treatment of acute ischemic stroke attempts to open the occluded blood vessels in order to reestablish blood flow and to improve outcomes [1]. In one of the earliest clinical trials of IAT [8], the rates of all intracranial hemorrhages (ICH) at 24 hours and mortality at 90 days were approximately 42% and 27%, respectively. In a study of patients who received IAT (together with other endovascular treatments) after 8 hours, Natarajan and colleagues documented approximate rates of 33% for both mortality at 90 days and immediate hemorrhage (subarachnoid and intracranial) [21]. To gain further insight into possible clinical benefits of IAT relative to IVT, we performed a meta-analysis to evaluate the efficacy and safety of IAT and IVT in patients with acute ischemic stroke. A limited number of randomized prospective studies have compared the efficacy and safety of IVT and IAT This meta-analysis investigated possible clinical benefits of IAT relative to IVT in patients with acute ischemic stroke.

Methods

Results

Conclusion