WSO - January 2024 - 16

1184369
WSO
International Journal of StrokeQureshi et al.
Review
Mechanical thrombectomy with
intra-arterial thrombolysis versus
mechanical thrombectomy alone in
patients with acute ischemic stroke:
A systematic review and meta-analysis
Adnan I Qureshi1 , Abdullah Lodhi1 , Iqra N Akhtar1,
Xiaoyu Ma1, Danish Kherani2 , Chun Shing Kwok3
Daniel E Ford4, Daniel F Hanley4 , Ameer E Hassan5
Thanh N Nguyen6, Alejandro M Spiotta7 and Syed F Zaidi8
,
,
Abstract
Background: There is conflicting evidence as to whether intra-arterial thrombolysis (IAT) adds benefit in patients with
acute stroke who undergo mechanical thrombectomy (MT).
Methods: We conducted a systematic review to identify studies that evaluate IAT in patients with acute stroke who
undergo MT. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science
until February 2023. Statistical pooling with random effects meta-analysis was undertaken to evaluate odds of functional
independence, mortality, and near-complete or complete angiographic recanalization with IAT compared to no IAT.
Results: A total of 18 studies were included (3 matched, 14 unmatched, and 1 randomized). The odds ratio (OR) for
functional independence (modified Rankin Scale: 0-2) at 90 days was 1.14 (95% confidence interval (CI): 0.95-1.37,
p = 0.17, 16 studies involving 7572 patients) with IAT with moderate between-study heterogeneity (I2 = 38.1%). The OR
for functional independence with IAT was 1.28 (95% CI: 0.92-1.78, p = 0.15) in studies that were either matched or randomized
and 1.24 (95% CI: 0.97-1.58, p = 0.08) in studies with the highest quality score. IAT was associated with higher
odds of near-complete or complete angiographic recanalization (OR: 1.65, 95% CI: 1.03-2.65, p = 0.04) in studies that
were either matched or of randomized comparisons.
Conclusion: Although the odds of functional independence appeared to be higher with IAT and MT compared with MT
alone, none of the results were statistically significant. A prominent effect of the design and quality of the studies was
observed on the association between IAT and functional independence at 90 days.
Keywords
Systematic review, meta-analysis, intra-arterial thrombolysis, mechanical thrombectomy, acute ischemic stroke
Received: 28 March 2023; accepted: 22 May 2023
1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
2Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA
3Department of Cardiology, University Hospitals of Birmingham NHS Trust, Birmingham, UK
4Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
5Department of Neurology, The University of Texas Rio Grande Valley, Harlingen, TX, USA
6Department of Neurology, Boston Medical Center, Boston, MA, USA
7Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
8Department of Neurology, The University of Toledo Medical Center, Toledo, OH, USA
Corresponding author:
Adnan I Qureshi, Department of Neurology, University of Missouri, One Hospital Drive CE507, Columbia, MO 65212, USA.
Email: qureshai@gmail.com
International Journal of Stroke, 19(1)
International Journal of Stroke
2024, Vol. 19(1) 16 -28
© 2023 World Stroke Organization
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DOI: 10.1177/17474930231184369
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