Effect of Intra-Arterial Thrombolysis Following Successful Endovascular Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Post-CHOICE Meta-Analysis

Authors

Mohamed Elfil, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Sherief Ghozy, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Ahmed Elmashad, Department of Neurology, University of Connecticut, Farmington, CT, USA.
Hazem S. Ghaith, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohammad Aladawi, Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla, NY, USA.
Ossama Yassin Mansour, Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Priyank Khandelwal, Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
Kaiz Asif, Ascension Health and University of Illinois-Chicago, Chicago, IL, USA.
May Nour, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Gabor Toth, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Fawaz Al-Mufti, Department of Neurology and Neurosurgery, New York Medical College at Westchester Medical Center, Valhalla, NY, USA. Electronic address: Fawaz.al-mufti@wmchealth.org.Follow

Author Type(s)

Student, Faculty

Journal Title

Journal of Stroke and Cerebrovascular Diseases

First Page

107194

Document Type

Article

Publication Date

8-1-2023

Department

Neurology

Abstract

INTRODUCTION: Endovascular thrombectomy (EVT) is the standard treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Although > 70% of patients in the trials assessing EVT for AIS-LVO had successful recanalization, only a third ultimately achieved favorable outcomes. A "no-reflow" phenomenon due to distal microcirculation disruption might contribute to such suboptimal outcomes. Combining intra-arterial (IA) tissue plasminogen activator (tPA) and EVT to reduce the distal microthrombi burden was investigated in a few studies. We present a pooled-data meta-analysis of the existing evidence of this combinatorial treatment. METHODS: We followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) recommendations. We aimed to include all original studies investigating EVT plus IA tPA in AIS-LVO patients. Using R software, we calculated pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI). A fixed-effects model was adopted to evaluate pooled data. RESULTS: Five studies satisfied the inclusion criteria. Successful recanalization was comparable between the IA tPA and control groups at 82.9% and 82.32% respectively. The 90-day functional independence was similar between both groups (OR= 1.25; 95% CI= 0.92-1.70; P= 0.154). Symptomatic intracranial hemorrhage (sICH) was also comparable between both groups (OR= 0.66; 95% CI= 0.34-1.26; P= 0.304). CONCLUSION: Our current meta-analysis does not show significant differences between EVT alone and EVT plus IA tPA in terms of functional independence or sICH. However, with the limited number of studies and included patients, more randomized controlled trials (RCTs) are needed to further investigate the benefits and safety of combined EVT and IA tPA.

Recommended Citation

Elfil, M., Ghozy, S., Elmashad, A., Ghaith, H. S., Aladawi, M., Dicpinigaitis, A. J., Mansour, O. Y., Khandelwal, P., Asif, K., Nour, M., Toth, G., & Al-Mufti, F. (2023). Effect of Intra-Arterial Thrombolysis Following Successful Endovascular Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: A Post-CHOICE Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases, 32 (8), 107194. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107194