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IV thrombolysis initiated before transfer for endovascular stroke thrombectomy: a systematic review and meta-analysis

Background and Objectives The role of IV thrombolysis (IVT) in patients with large vessel occlusions (LVOs) administered before transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) is questioned. - Methods We included observational studies of patients with an LVO receiv...

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Main Authors: Katsanos, Aristeides H. (Author) , Sarraj, Amrou (Author) , Froehler, Michael (Author) , Purrucker, Jan (Author) , Goyal, Nitin (Author) , Regenhardt, Robert William (Author) , Palaiodimou, Lina (Author) , Mueller-Kronast, Nils H. (Author) , Lemmens, Robin (Author) , Schellinger, Peter (Author) , Sacco, Simona (Author) , Turc, Guillaume (Author) , Alexandrov, Andrei V. (Author) , Tsivgoulis, Georgios (Author)
Format: Article (Journal)
Language:English
Published: April 04, 2023
In: Neurology
Year: 2023, Volume: 100, Issue: 14, Pages: e1436-e1443
ISSN:1526-632X
DOI:10.1212/WNL.0000000000206784
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1212/WNL.0000000000206784
Verlag, lizenzpflichtig, Volltext: https://n.neurology.org/content/100/14/e1436
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Author Notes:Aristeidis H. Katsanos, Amrou Sarraj, Michael Froehler, Jan Purrucker, Nitin Goyal, Robert William Regenhardt, Lina Palaiodimou, Nils H. Mueller-Kronast, Robin Lemmens, Peter D. Schellinger, Simona Sacco, Guillaume Turc, Andrei V. Alexandrov, Georgios Tsivgoulis
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Summary:Background and Objectives The role of IV thrombolysis (IVT) in patients with large vessel occlusions (LVOs) administered before transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) is questioned. - Methods We included observational studies of patients with an LVO receiving IVT at a PSC before their endovascular thrombectomy (EVT) transfer compared with those receiving EVT alone. Efficacy outcomes included excellent or good functional outcomes (modified Rankin Scale [mRS] scores of 0-1 or 0-2, respectively) and reduced disability (mRS shift analysis) at 3 months. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 hours and 3-month all-cause mortality. Associations are reported with crude odds ratios (ORs) and adjusted ORs (aORs). - Results We identified 6 studies, including 1,723 participants (mean age: 71 years, 51% women; 53% treated with IVT at a PSC). The mean onset-to-groin puncture time did not differ between the 2 groups (mean difference: −20 minutes, 95% CI −115.89 to 76.04). Patients receiving IVT before transfer had higher odds of 3-month reduced disability (common OR = 1.98, 95% CI 1.17-3.35), excellent (OR = 1.70, 95% CI 1.28-2.26), and good (OR = 1.62.95% CI 1.15-2.29) functional outcomes, with no increased sICH (OR = 0.87, 95% CI 0.54-1.39) or mortality (OR = 0.55, 95% CI 0.37-0.83) risks. In the adjusted analyses, patients receiving IVT at a PSC had higher odds of excellent functional outcome (aOR = 1.32, 95% CI 1.00-1.74) and a lower probability for mortality (aOR = 0.50, 95% CI 0.27-0.93). - Discussion Patients with LVO receiving IVT at a PSC before an EVT transfer have a higher likelihood of excellent functional recovery and lower odds of mortality, with no increase in sICH and onset-to-groin puncture times, compared with those transferred for EVT without previously receiving IVT.
Item Description:Gesehen am 08.08.2023
Physical Description:Online Resource
ISSN:1526-632X
DOI:10.1212/WNL.0000000000206784

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