Comparative Effectiveness of Intravenous Thrombolysis plus Mechanical Thrombectomy versus Mechanical Thrombectomy Alone in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: This meta-analysis investigates the effectiveness of Bridging Therapy (BT) versus mechanical thrombectomy (MT) alone in treating acute ischemic stroke. Methods: Two independent reviewers assessed two-arm clinical trials from Scopus, PubMed, Web of Science, and the Cochrane Library up to January 2024. Data extraction and quality were evaluated using the ROBINS-2 tool. Our primary outcome were improvement in NIHSS scores and 90-day modified Rankin Scale (mRS) score. Results: The meta-analysis, which included 2,638 participants from 8 randomized controlled trials, found that Bridging therapy resulted in a greater improvement in NIHSS scores from baseline compared to endovascular treatment alone (MD 0.96, 95% CI [0.73–1.20], p<0.00001). Additionally, Bridging therapy group achieved successful recanalization more frequently before and after thrombectomy Thrombectomy alone hat a shorter time from stroke onset to groin puncture compared to bridging therapy (MD 9.91, 95% CI [4.31–15.52], p=0.005). Functional outcomes, mortality rates, symptomatic intracerebral hemorrhage rates, and long-term recovery metrics, such as Barthel Index and modified Rankin Scale scores, were comparable between both treatment approaches. Conclusion Bridging therapy is superior to endovascular treatment alone based on NIHSS score improvement and successful reperfusion rates before und after thrombectomy. Despite MT alone demonstrating a shorter time from stroke onset to groin puncture (mean difference of 9.91 minutes), it did not contribute to greater NIHSS improvement at 24 hours and 7 days. Further trials with larger sample sizes are warranted to enhance precision in clinical guidance.