Table_1.DOCX

Abstract

Background and Purpose — It is unclear whether endovascular thrombectomy alone compared with intravenous thrombolysis combination with endovascular thrombectomy can achieve similar neurological outcomes in patients with acute large vessel occlusion stroke. We aimed to perform a systematic review and meta-analysis of randomized controlled trials to compare endovascular thrombectomy alone or intravenous thrombolysis plus endovascular thrombectomy in this population. Methods — We systematically searched PubMed, Embase and ClinicalTrials.gov. We restricted our search to randomized clinical trials that examined the clinical outcomes of endovascular thrombectomy alone versus intravenous thrombolysis plus endovascular thrombectomy. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects meta-analyses were used for evaluating all outcomes. Results — Total 3 randomized controlled trials with 1092 individuals enrolled were included in the meta-analysis, including 543 (49.7%) who received endovascular thrombectomy alone and 549 (50.3%) who received intravenous thrombolysis plus endovascular thrombectomy. The primary outcome of 90-day functional independence (mRS score ≤ 2) was 44.6% (242/543) in the endovascular thrombectomy alone group vs 42.8% (235/549) in the alteplase with endovascular thrombectomy group (OR, 1.08 [95% CI, 0.85 - 1.38]; P = 0.0539). Among prespecified secondary outcomes, no significant between-group differences were found in excellent outcome (mRS score ≤ 1) (OR, 1.12 [95% CI, 0.85 - 1.47]; P = 0.418), mortality at 90 days (OR, 0.93 [95% CI, 0.68 - 1.29]; P = 0.673), successful reperfusion (TICI 2b-3) (OR, 0.75 [95% CI, 0.54 - 1.05]; P = 0.099) and sICH (OR, 0.72 [95% CI, 0.45 - 1.15]; P = 0.171). Conclusions — Among patients with acute ischemic stroke in the anterior circulation within 4.5 hours from onset, endovascular thrombectomy alone was noninferior to combined intravenous thrombolysis and endovascular thrombectomy.