Mechanical thrombectomy versus intravenous thrombolysis for distal large-vessel occlusion: a systematic review and meta-analysis of observational studies

Abstract

OBJECTIVE While several studies have compared the feasibility and safety of mechanical thrombectomy (MT) for distal large-vessel occlusion (LVO) strokes in patients, few studies have compared MT with intravenous thrombolysis (IVT) alone. The purpose of this systematic review was to compare the effectiveness and safety between MT and standard medical management with IVT alone for patients with distal LVOs. METHODS PubMed, Google Scholar, Embase, Scopus, Web of Science, Ovid Medline, and Cochrane Library were searched in order to identify studies that directly compared MT with IVT for distal LVOs (anterior cerebral artery A2, middle cerebral artery M3–4, and posterior cerebral artery P2–4). Primary outcomes of interest included a modified Rankin Scale (mRS) score of 0 to 2 at 90 days posttreatment, occurrence of symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days posttreatment. RESULTS Four studies representing a total of 381 patients were included in this meta-analysis. The pooled results indicated that the proportion of patients with an mRS score of 0 to 2 at 90 days (OR 1.16, 95% CI 0.23–5.93; p = 0.861), the occurrence of sICH (OR 2.45, 95% CI 0.75–8.03; p = 0.140), and the mortality rate at 90 days (OR 1.73, 95% CI 0.66–4.55; p = 0.263) did not differ between patients who underwent MT and those who received IVT alone. CONCLUSIONS The meta-analysis did not demonstrate a significant difference between MT and standard medical management with regard to favorable outcome, occurrence of sICH, or 90-day mortality. Prospective clinical trials are needed to further compare the efficacy of MT with IVT alone for distal vessel occlusion.

Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique

“…However, it is still important to note that there is a paucity of data on the natural history of DVO and a significant proportion of these patients are expected to have a good outcome without intervention 22. In subsets of IV-tPA eligible DVO patients, up to a 50% good outcome rate has been reported with the limitation of significant inter-study heterogeneity 23. Notably, in our cohort, patients underwent EVT for DVO when perfusion imaging demonstrated a perfusion deficit that corresponded, at least in part, to the admission deficits on examination after IV-tPA administration in eligible patients.…”

Meta-Analysis of the Effectiveness and Safety of Intravenous Thrombolysis in Patients with Acute Cerebral Infarction

“…Acute cerebral infarction caused by intravenous thrombolysis has a high fatality and disability rate. At the same time, thrombus formed during intravenous thrombolysis can also cause pulmonary vein thrombolysis and myocardial infarction [ 1 ]. Thus, standardized anticoagulation medication is a critical component of the overall management of patients receiving intravenous thrombolysis.…”

Mechanical Thrombectomy for Mild Acute Ischemic Stroke with Large-Vessel Occlusion: A Systematic Review and Meta-Analysis

“…A meta-analysis has been performed to compare the efficacy and safety between MT and IVT alone for patients with distal LVOs regardless of the severity of AIS in 2021 [30]. The results of that showed no significant difference between MT and IVT alone in favorable outcome, occurrence of sICH, or 90-day mortality [30]. Meta-analyses have been conducted to identify whether MT was associated with functional prognosis of AIS patients with an NIHSS score ≤8 and LVO [5, 31], while subjects of the present paper were limited to an NIHSS score ≤5.…”