Endovascular thrombectomy with or without systemic thrombolysis?

Georgios Tsivgoulis, Aristeidis H. Katsanos, Dimitris Mavridis, Anne Alexandrov, Georgios Magoufis, Adam Arthur, Valeria Caso, Peter D. Schellinger, Andrei Alexandrov

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objectives: Current recommendations advocate that pretreatment with intravenous thrombolysis (IVT) should first be offered to all eligible patients with emergent large vessel occlusion (ELVO) before an endovascular thrombectomy (ET) procedure. However, there are observational data that question the safety and efficacy of IVT pretreatment in patients with ELVO. Methods: We performed a meta-analysis of the included subgroups from ET randomized controlled trials (RCTs) to evaluate the comparative efficacy between direct ET without IVT pretreatment and bridging therapy (IVT and ET) in patients with ELVO. Results: We included a total of seven RCTs, including 1764 patients with ELVO (52.8% men). Patients receiving bridging therapy (IVT followed by ET) had lower rates (p = 0.041) of 90-day death/severe dependency (modified Rankin Scale-score of 5-6; 19.0%, 95% CI: 14.1-25.1%) compared with patients receiving only ET (31.0%, 95% CI: 21.2-42.9%). Moreover, patients receiving IVT and ET had a nonsignificant (p = 0.389) trend towards higher 90-day functional independence rates (51.4%, 95% CI: 42.5-60.1%) compared with patients undergoing only ET (41.7%, 95% CI: 24.1-61.7%). Finally, shift-analysis uncovered a nonsignificant trend towards functional improvement at 90 days for bridging therapy over ET (cOR = 1.28, 95% CI: 0.91-1.89; p = 0.155). It should be noted that patients included in the present meta-analysis were not randomized to receive IVT, and thus the two groups (bridging therapy versus ET monotherapy) may differ in terms of baseline characteristics and, in particular, in terms of onset to groin puncture time and thus the risk of confounding bias cannot be ruled out. Conclusion: Despite the limitations and the risk of confounding bias, our findings contradict the recent notion regarding potential equality between ET and bridging therapy in ELVO patients and suggest that IVT and ET are complementary therapies that should be pursued in a parallel and noncompeting fashion.

Original languageEnglish (US)
Pages (from-to)151-160
Number of pages10
JournalTherapeutic Advances in Neurological Disorders
Volume10
Issue number3
DOIs
StatePublished - Mar 1 2017

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Thrombectomy
Meta-Analysis
Randomized Controlled Trials
Endovascular Procedures
Groin
Therapeutics
Complementary Therapies
Group Psychotherapy
Punctures

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Neurology
  • Clinical Neurology

Cite this

Endovascular thrombectomy with or without systemic thrombolysis? / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Mavridis, Dimitris; Alexandrov, Anne; Magoufis, Georgios; Arthur, Adam; Caso, Valeria; Schellinger, Peter D.; Alexandrov, Andrei.

In: Therapeutic Advances in Neurological Disorders, Vol. 10, No. 3, 01.03.2017, p. 151-160.

Research output: Contribution to journalArticle

Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Mavridis, Dimitris ; Alexandrov, Anne ; Magoufis, Georgios ; Arthur, Adam ; Caso, Valeria ; Schellinger, Peter D. ; Alexandrov, Andrei. / Endovascular thrombectomy with or without systemic thrombolysis?. In: Therapeutic Advances in Neurological Disorders. 2017 ; Vol. 10, No. 3. pp. 151-160.
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AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Mavridis, Dimitris

AU - Alexandrov, Anne

AU - Magoufis, Georgios

AU - Arthur, Adam

AU - Caso, Valeria

AU - Schellinger, Peter D.

AU - Alexandrov, Andrei

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