Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis

Research output: Contribution to journalArticle

Eva A. Mistry, Akshitkumar M. Mistry, Mohammad Obadah Nakawah, Rohan V. Chitale, Robert F. James, John Volpi, Matthew R. Fusco

BACKGROUND AND PURPOSE—: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS—: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT−IVT) pre-treatment with intravenous thrombolysis. RESULTS—: MT+IVT patients compared with MT−IVT patients had better functional outcomes (modified Rankin Scale score, 0–2; summary odds ratio [OR], 1.27 [95% confidence interval (CI), 1.05–1.55]; P=0.02; n=1769/1174), lower mortality (OR, 0.71 [95% CI, 0.55–0.91]; P=0.006; n=1774/1202), and higher rate of successful recanalization (OR, 1.46 [95% CI, 1.09–1.96]; P=0.01; n=1652/1216) without having increased odds of symptomatic intracerebral hemorrhage (OR, 1.11 [95% CI, 0.69–1.77]; P=0.67; n=1471/1143). A greater number of MT+IVT patients required ≤2 passes with a neurothrombectomy device to achieve successful recanalization (OR, 2.06 [95% CI, 1.37–3.10]; P=0.0005; n=316/231). CONCLUSIONS—: Our results demonstrated that MT+IVT patients had better functional outcomes, lower mortality, higher rate of successful recanalization, requiring lower number of device passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT−IVT patients. The results support the current guidelines of offering intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy. Because the data are compiled from studies where the 2 groups differed based on eligibility for intravenous thrombolysis, randomized trials are necessary to accurately evaluate the added value of intravenous thrombolysis in patients treated with mechanical thrombectomy.

Original languageEnglish (US)
JournalStroke
DOIs
StateAccepted/In press - Jul 26 2017

PMID: 28747462

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Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients : A Meta-Analysis. / Mistry, Eva A.; Mistry, Akshitkumar M.; Nakawah, Mohammad Obadah; Chitale, Rohan V.; James, Robert F.; Volpi, John; Fusco, Matthew R.

In: Stroke, 26.07.2017.

Research output: Contribution to journalArticle

Harvard

Mistry, EA, Mistry, AM, Nakawah, MO, Chitale, RV, James, RF, Volpi, J & Fusco, MR 2017, 'Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis' Stroke. https://doi.org/10.1161/STROKEAHA.117.017320

APA

Mistry, E. A., Mistry, A. M., Nakawah, M. O., Chitale, R. V., James, R. F., Volpi, J., & Fusco, M. R. (Accepted/In press). Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis. Stroke. https://doi.org/10.1161/STROKEAHA.117.017320

Vancouver

Mistry EA, Mistry AM, Nakawah MO, Chitale RV, James RF, Volpi J et al. Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis. Stroke. 2017 Jul 26. https://doi.org/10.1161/STROKEAHA.117.017320

Author

Mistry, Eva A. ; Mistry, Akshitkumar M. ; Nakawah, Mohammad Obadah ; Chitale, Rohan V. ; James, Robert F. ; Volpi, John ; Fusco, Matthew R. / Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients : A Meta-Analysis. In: Stroke. 2017.

BibTeX

@article{40fcf2bf3ede4c3295d6e25ebf46677d,
title = "Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis",
abstract = "BACKGROUND AND PURPOSE—: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS—: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT−IVT) pre-treatment with intravenous thrombolysis. RESULTS—: MT+IVT patients compared with MT−IVT patients had better functional outcomes (modified Rankin Scale score, 0–2; summary odds ratio [OR], 1.27 [95{\%} confidence interval (CI), 1.05–1.55]; P=0.02; n=1769/1174), lower mortality (OR, 0.71 [95{\%} CI, 0.55–0.91]; P=0.006; n=1774/1202), and higher rate of successful recanalization (OR, 1.46 [95{\%} CI, 1.09–1.96]; P=0.01; n=1652/1216) without having increased odds of symptomatic intracerebral hemorrhage (OR, 1.11 [95{\%} CI, 0.69–1.77]; P=0.67; n=1471/1143). A greater number of MT+IVT patients required ≤2 passes with a neurothrombectomy device to achieve successful recanalization (OR, 2.06 [95{\%} CI, 1.37–3.10]; P=0.0005; n=316/231). CONCLUSIONS—: Our results demonstrated that MT+IVT patients had better functional outcomes, lower mortality, higher rate of successful recanalization, requiring lower number of device passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT−IVT patients. The results support the current guidelines of offering intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy. Because the data are compiled from studies where the 2 groups differed based on eligibility for intravenous thrombolysis, randomized trials are necessary to accurately evaluate the added value of intravenous thrombolysis in patients treated with mechanical thrombectomy.",
author = "Mistry, {Eva A.} and Mistry, {Akshitkumar M.} and Nakawah, {Mohammad Obadah} and Chitale, {Rohan V.} and James, {Robert F.} and John Volpi and Fusco, {Matthew R.}",
year = "2017",
month = "7",
day = "26",
doi = "10.1161/STROKEAHA.117.017320",
language = "English (US)",
journal = "Stroke",
issn = "0039-2499",

}

RIS

TY - JOUR

T1 - Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients

T2 - Stroke

AU - Mistry, Eva A.

AU - Mistry, Akshitkumar M.

AU - Nakawah, Mohammad Obadah

AU - Chitale, Rohan V.

AU - James, Robert F.

AU - Volpi, John

AU - Fusco, Matthew R.

PY - 2017/7/26

Y1 - 2017/7/26

N2 - BACKGROUND AND PURPOSE—: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS—: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT−IVT) pre-treatment with intravenous thrombolysis. RESULTS—: MT+IVT patients compared with MT−IVT patients had better functional outcomes (modified Rankin Scale score, 0–2; summary odds ratio [OR], 1.27 [95% confidence interval (CI), 1.05–1.55]; P=0.02; n=1769/1174), lower mortality (OR, 0.71 [95% CI, 0.55–0.91]; P=0.006; n=1774/1202), and higher rate of successful recanalization (OR, 1.46 [95% CI, 1.09–1.96]; P=0.01; n=1652/1216) without having increased odds of symptomatic intracerebral hemorrhage (OR, 1.11 [95% CI, 0.69–1.77]; P=0.67; n=1471/1143). A greater number of MT+IVT patients required ≤2 passes with a neurothrombectomy device to achieve successful recanalization (OR, 2.06 [95% CI, 1.37–3.10]; P=0.0005; n=316/231). CONCLUSIONS—: Our results demonstrated that MT+IVT patients had better functional outcomes, lower mortality, higher rate of successful recanalization, requiring lower number of device passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT−IVT patients. The results support the current guidelines of offering intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy. Because the data are compiled from studies where the 2 groups differed based on eligibility for intravenous thrombolysis, randomized trials are necessary to accurately evaluate the added value of intravenous thrombolysis in patients treated with mechanical thrombectomy.

AB - BACKGROUND AND PURPOSE—: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. METHODS—: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional outcome (modified Rankin Scale) at 90 days, successful recanalization rate, and symptomatic intracerebral hemorrhage rate differed between patients who underwent mechanical thrombectomy with (MT+IVT) and without (MT−IVT) pre-treatment with intravenous thrombolysis. RESULTS—: MT+IVT patients compared with MT−IVT patients had better functional outcomes (modified Rankin Scale score, 0–2; summary odds ratio [OR], 1.27 [95% confidence interval (CI), 1.05–1.55]; P=0.02; n=1769/1174), lower mortality (OR, 0.71 [95% CI, 0.55–0.91]; P=0.006; n=1774/1202), and higher rate of successful recanalization (OR, 1.46 [95% CI, 1.09–1.96]; P=0.01; n=1652/1216) without having increased odds of symptomatic intracerebral hemorrhage (OR, 1.11 [95% CI, 0.69–1.77]; P=0.67; n=1471/1143). A greater number of MT+IVT patients required ≤2 passes with a neurothrombectomy device to achieve successful recanalization (OR, 2.06 [95% CI, 1.37–3.10]; P=0.0005; n=316/231). CONCLUSIONS—: Our results demonstrated that MT+IVT patients had better functional outcomes, lower mortality, higher rate of successful recanalization, requiring lower number of device passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT−IVT patients. The results support the current guidelines of offering intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy. Because the data are compiled from studies where the 2 groups differed based on eligibility for intravenous thrombolysis, randomized trials are necessary to accurately evaluate the added value of intravenous thrombolysis in patients treated with mechanical thrombectomy.

UR - http://www.scopus.com/inward/record.url?scp=85026359594&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026359594&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.017320

DO - 10.1161/STROKEAHA.117.017320

M3 - Article

JO - Stroke

JF - Stroke

SN - 0039-2499

ER -

ID: 32338194