Yang Zeni, Zhang Wentai, Xu Yonggang, Ding Yuwei, Liu Chao, Shen Zhiyuan, Wu Jiwei, Guo Yu, Luo Wenmiao
School of Basic Medicine, Capital Medical University, Beijing, China.
Department of Thoracic Surgery, Peking University First Hospital, Beijing, China.
Eur Stroke J. 2025 Apr 14:23969873251334047. doi: 10.1177/23969873251334047.
The impact of intra-arterial thrombolysis (IAT) following successful endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains uncertain. This study aims to assess the efficacy and safety of IAT as an adjunct to EVT in patients with AIS-LVO.
We searched PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) that compared EVT + IAT with EVT-only for AIS-LVO. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days. Secondary outcomes included functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), and mortality. The pooled data were analyzed using random-effects models.
A total of four RCTs, involving 1395 patients, were included in the analysis. The results showed that patients who received EVT + IAT had a significantly higher likelihood of achieving an excellent functional outcome at 90 days compared to those who received EVT-only (risk ratio [RR], 1.16; 95% confidence interval [CI], 1.03-1.31). No statistically significant differences were observed between the EVT + IAT and EVT-only groups in terms of 90-day functional independence (RR, 1.03; 95% CI, 0.94-1.13), sICH (RR, 1.30; 95% CI, 0.80-2.13), or 90-day mortality (RR, 0.94; 95% CI, 0.76-1.17).
Among patients with AIS-LVO who have undergone successful EVT, the use of adjunct IAT, compared to no additional treatment, was associated with a greater likelihood of achieving an excellent functional outcome at 90 days.
CRD42024602099.
对于因大血管闭塞（LVO）导致的急性缺血性卒中（AIS）患者，在成功进行血管内血栓切除术（EVT）后进行动脉内溶栓（IAT）的影响仍不确定。本研究旨在评估IAT作为AIS-LVO患者EVT辅助治疗的有效性和安全性。
我们检索了PubMed、Embase和Cochrane数据库，以确定比较EVT联合IAT与单纯EVT治疗AIS-LVO的随机对照试验（RCT）。主要结局是良好的功能结局，定义为90天时改良Rankin量表（mRS）评分为0-1分。次要结局包括功能独立性（mRS 0-2）、症状性颅内出血（sICH）和死亡率。使用随机效应模型对汇总数据进行分析。
分析共纳入4项RCT，涉及1395例患者。结果显示，与单纯接受EVT的患者相比，接受EVT联合IAT的患者在90天时获得良好功能结局的可能性显著更高（风险比[RR]，1.16；95%置信区间[CI]，1.03-1.31）。在90天功能独立性（RR，1.03；95% CI，0.94-1.13）、sICH（RR，1.30；95% CI，0.80-2.13）或90天死亡率（RR，0.94；95% CI，0.76-1.17）方面，EVT联合IAT组与单纯EVT组之间未观察到统计学显著差异。
在成功接受EVT的AIS-LVO患者中，与不进行额外治疗相比，使用辅助IAT在90天时获得良好功能结局的可能性更大。
CRD42024602099。
