Meta-analysis of direct endovascular thrombectomy vs bridging therapy in the management of acute ischemic stroke with large vessel occlusion

Debates persist when using intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). This systematic review and meta-analysis synthesized evidence on outcomes in patients with acute ischemic stroke due to large vessel occl...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2024-01, Vol.236, p.108070-108070, Article 108070
Main Authors: Shafique, Muhammad Ashir, Ali, Syed Muhammad Sinaan, Mustafa, Muhammad Saqlain, Aamir, Ali, Khuhro, Muhammad Saleem, Arbani, Naeemullah, Raza, Rana Ali, Abbasi, Mohammad Bilal, Lucke-Wold, Brandon
Format: Article
Language:English
Subjects:
Acute ischemic stroke
Bias
Brain Ischemia - drug therapy
Brain Ischemia - surgery
Bridging therapy
Cardiovascular system
Clinical trials
Dissection
Embolization
Endovascular thrombectomy
Fibrinolytic Agents - therapeutic use
Hemorrhage
Humans
Intracranial Hemorrhages - drug therapy
Intravenous thrombolysis
Intubation
Ischemia
Ischemic Stroke - drug therapy
Ischemic Stroke - surgery
Mechanical thrombectomy
Meta-analysis
Mortality
Observational studies
Occlusion
Patients
Safety
Sensitivity analysis
Stroke
Stroke - drug therapy
Stroke - surgery
Thrombectomy - adverse effects
Thrombolysis
Thrombolytic Therapy - adverse effects
Treatment Outcome
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Summary:Debates persist when using intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). This systematic review and meta-analysis synthesized evidence on outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO), comparing bridging therapy (BT) with MT alone. We conducted searches of PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to July 2023 to identify pertinent clinical trials and observational studies. 76 studies, involving 37,658 patients, revealed no significant difference in 90-day functional independence between DEVT and BT. However, a trend favoring BT for achieving functional independence with a modified Rankin Scale (mRS) of 0–1 was observed, having Odds ratio (OR) of 0.75 (95% CI 0.66–0.86; p 
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2023.108070