TY - JOUR
T1 - Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion
T2 - A systematic review and meta-analysis of 1096 patients
AU - Lee, Keng Siang
AU - Siow, Isabel
AU - Zhang, John J.Y.
AU - Syn, Nicholas L.
AU - Gillespie, Conor S.
AU - Yuen, Linus Z.H.
AU - Anil, Gopinathan
AU - Yang, Cunli
AU - Chan, Bernard P.L.
AU - Sharma, Vijay Kumar
AU - Teoh, Hock Luen
AU - Mingxue, Jing
AU - Teo, Kevin Soon Hwee
AU - Myint, May Zin
AU - Bhogal, Pervinder
AU - Meyer, Lukas
AU - Schob, Stefan
AU - Sia, Ching Hui
AU - Mpotsaris, Anastasios
AU - Maus, Volker
AU - Andersson, Tommy
AU - Arnberg, Fabian
AU - Gontu, Vamsi Krishna
AU - Lee, Tsong Hai
AU - Tan, Benjamin Y.Q.
AU - Yeo, Leonard L.L.
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).OBJECTIVE: To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.METHODS: Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).RESULTS: Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).CONCLUSIONS: In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
AB - BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).OBJECTIVE: To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.METHODS: Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).RESULTS: Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).CONCLUSIONS: In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
KW - Artery
KW - Complication
KW - Stroke
KW - Thrombectomy
KW - Thrombolysis
KW - Brain Ischemia/drug therapy
KW - Intracranial Hemorrhages/complications
KW - Humans
KW - Fibrinolytic Agents/therapeutic use
KW - Survival Rate
KW - Treatment Outcome
KW - Stroke/drug therapy
KW - Basilar Artery/diagnostic imaging
KW - Subarachnoid Hemorrhage/complications
KW - Thrombolytic Therapy
KW - Ischemic Stroke/complications
KW - Mechanical Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85140270717&partnerID=8YFLogxK
U2 - 10.1136/jnis-2022-019510
DO - 10.1136/jnis-2022-019510
M3 - 文章
C2 - 36175014
AN - SCOPUS:85140270717
SN - 1759-8478
VL - 15
SP - 1039
EP - 1045
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 10
ER -