Intravenous Thrombolysis Plus Mechanical Thrombectomy Improves Stroke Outcomes

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Patients who received both mechanical thrombectomy and IV tPA had lower mortality and better functional outcomes.
Patients who received both mechanical thrombectomy and IV tPA had lower mortality and better functional outcomes.

Patients with acute ischemic stroke undergoing mechanical thrombectomy with intravenous thrombolysis (MT+IVT) have lower mortality, better functional outcomes, and higher rates of successful recanalization compared with patients undergoing mechanical thrombectomy without intravenous thrombolysis (MT−IVT), according to findings from a meta-analysis published in Stroke.

Investigators performed a meta-analysis consisting of 13 studies to examine the differences in the successful recanalization rate, 90-day functional outcome, and symptomatic intracerebral hemorrhage rate between patients undergoing MT+IVT and MT−IVT for acute ischemic stroke.

According to the findings, patients undergoing MT+IVT had significantly better functional outcomes compared with MT−IVT (odds ratio [OR], 1.27; 95% CI, 1.05-1.55; P =.02). In addition, the MT+IVT group also experienced lower rates of mortality (OR, 0.71; 95% CI, 0.55-0.91; P =.006). 

Successful recanalization was also higher in the MT+IVT group vs MT−IVT (OR, 1.46; 95% CI, 1.09-1.96; P =.01). Also, patients undergoing MT+IVT required fewer neurothrombectomy device passes (≤2) for successful recanalization (OR, 2.06; 95% CI, 1.37-3.10; P =.0005).

Evaluation of patients who received MT+IVT vs MT−IVT in nonrandomized studies found a strong trend toward good functional outcome (P =.06) and lower mortality (P =.08). A combined analysis of randomized and nonrandomized studies found that patients undergoing MT+IVT had overall better functional outcomes (P =.02) and lower mortality (P =.006) compared with patients receiving MT−IVT.

According to the researchers, one potential limitation to this meta-analysis was the lack of randomization of participants undergoing mechanical thrombectomy to either intravenous thrombolysis or control.

The investigators concluded that the results of this meta-analysis "support the current guidelines to offer intravenous thrombolysis to eligible patients even if they are being considered for mechanical thrombectomy."

Reference

Mistry EA, Mistry AM, Nakawah MO, et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Stroke. 2017;48(9):2450-2456.

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