Meta-analysis Finds Thrombolysis With Alteplase Followed by Mechanical Thrombectomy Improves Large Vessel Occlusion Stroke Outcome
A new meta-analysis shows people with large vessel occlusion (LVO)-related ischemic stroke treated with thrombolysis and mechanical thrombectomy within 4.5 hours of symptom onset have better outcomes than those treated with thrombectomy alone. In this meta-analysis, published in Neurology, alteplase was used for thrombolysis in 41 studies involving 14,885 people, mean age 70. Of the people with LVO-related strokes treated, 8,238 had both thrombolysis and mechanical thrombectomy and 6,647 had mechanical thrombectomy alone.
Individuals who had both thrombolysis and mechanical thrombectomy had 25% higher odds of reperfusion and 29% higher odds of being able to live independently after 3 months—an anticipated 34 additional people out of every 1,000 having functional recovery. People treated with both thrombolysis and thrombectomy, known as bridging therapy, had 31% lower odds of death at 90 days compared with thrombectomy alone. Rates of brain hemorrhage were similar between the 2 groups.
Gabriela Trifan, MD, of the University of Illinois Chicago, an author of the meta-analysis said, this "demonstrates that thrombolysis is safe and does not increase the risk of hemorrhage or delay the start of clot removal. . . . our analysis suggests that using thrombolysis and mechanical thrombectomy may be associated with better outcomes compared with treating people with mechanical thrombolysis only.
Analyses of the 6 most recent high-quality randomized clinical trials, showed no differences in functional independence and safety outcomes with thrombolysis and mechanical thrombectomy together vs thrombectomy alone.
“While these results are not strong enough to change practice at this time, they constitute a step forward into the concept of individualized medicine, where for selected patients in the appropriate clinical settings, clot removal may be as efficient and safe as bridging therapy,” said Trifan.