Endovascular Thrombectomy with or without Thrombolysis for Stroke: A Systematic Review

Introduction: We aimed to systematically update the evidence from randomized trials comparing EVT alone versus EVT with bridging thrombolysis.

Method(s): We searched MEDLINE, EMBASE, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT with or without IVT in patients presenting with stroke secondary to a large vessel occlusion. We conducted meta-analyses to compare favorable functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH), between EVT and EVT with IVT. We assessed risk of bias using the Cochrane risk-of-bias tool and certainty of evidence for each outcome using the GRADE approach.

Result(s): We included six studies with a total of 2,336 participants. We found low-certainty evidence that there is possibly a small decrease in the proportion of patients with favorable functional outcome with an mRS of 0 to 2 at 90 days for those who underwent EVT alone compared with EVT with IVT.

Conclusion(s): Low-certainty evidence shows that there is possibly a small decrease in favorable functional outcome for patients with EVT alone compared with EVT plus IVT.

Publication History

Article published online:
09 February 2023