A Meta-analysis Of The Efficacy And Safety Of Mechanical Thrombectomy And Bridging Intravenous Thrombolysis For Acute Ischemic Stroke

Objective:This meta-analysis mainly compares the efficacy and safety of bridging and non-bridging intravenous thrombolysis before mechanical thrombectomy for the treatment of acute ischemic stroke(AIS)caused by large vessel occlusion.Method:Search articles from databases(Pubmed,Embase,Cochrane library,Google schalor,China HowNet,Wanfang Database,and Weipu Database)according to the retrieval style,and check out the articles according to the inclusion and exclusion criteria,and then check the included articles.Quality evaluation.When the heterogeneity is less than 50%,a meta-analysis is performed using a fixed effect model.Egger’s regression test is used to assess publication bias.Results:A total of 8 studies were included.A total of 1827 cases were included in the analysis.Of these,1096 patients underwent mechanical thrombectomy and bridged intravenous thrombolysis,and 731 patients underwent mechanical thrombectomy alone.Comparison of the combined treatment group and the mechanical thrombectomy group alone:recanalization rate(grade 2b-3)79%vs 76%(OR=1.09,95%CI 0.87-1.38,p=0.46),functional independence rate at 90 days(mRS score 0-2)47.4%vs 42.7%(OR=1.21,95%CI 1.00-1.47,p=0.06),symptomatic intracranial hemorrhage 5.5%vs 5.9%(OR=0.92,95%CI 0.60-1.40,p=0.69)The differences were not statistically significant;the 90-day mortality rate was 20.3%vs 24.9%(OR=0.73,95%CI 0.58-0.93,p=0.010)and the difference was statistically significant.A total of 3 studies were included in the subgroup analysis.A total of 731 patients were extracted,including 510 mechanical thrombectomy and bridging intravenous thrombolysis,and 221 patients who had no intravenous thrombolytic contraindication but only mechanical thrombectomy.The results analyzed the recanalization rate and 90-day function.Independent rate mRS scores were not significantly different between the two groups(p>0.05),and there were no significant differences in mortality within 90 and 24-hour symptomatic cerebral hemorrhage rate(p>0.05),but it was used from the patient’s onset to inguinal puncture.The time of direct mechanical thrombectomy was significantly shortened,and the difference was statistically significant(p<0.05).Conclusion:Intravenous thrombolytic therapy before mechanical thrombectomy can reduce the 90-day mortality of patients with AIS caused by large vessel occlusion,and the clinical prognosis and bleeding rate of the two groups of patients are not statistically significant,but have comparative value.There is no clear evidence as to whether intravenous thrombolysis is bridged before mechanical thrombectomy,and a large number of prospective randomized controlled trials are needed to determine whether the use of intravenous thrombolytic pretreatment before mechanical thrombectomy benefits patients and the specific beneficiaries.