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Abstract 055: Intravenous Thrombolysis Before Endovascular Therapy for Acute Ischemic Stroke due to Tandem Lesions: A Systematic Review and Meta‐Analysis
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Abstract 055: Intravenous Thrombolysis Before Endovascular Therapy for Acute Ischemic Stroke due to Tandem Lesions: A Systematic Review and Meta‐Analysis

A Rodriguez-Calienes, M Vilca-Salas, J Z Gao, J Huynh, A Manazir, A Venkatesan, Y Lu, C Morán-Mariños and S Ortega-Gutierrez
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.055
PMCID: PMC12773877
url
https://doi.org/10.1161/SVIN.04.suppl_1.055View
Published (Version of record) Open Access

Abstract

IntroductionThe role of intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) remains under investigation, especially in patients with tandem lesions (TLs). The benefit of administering IVT before EVT in this context is uncertain due to the substantial clot burden and the additional requirement for periprocedural antiplatelet therapy during acute carotid stenting (CAS). We aimed to systematically review and meta‐analyze the literature to evaluate the comparative efficacy and safety of IVT plus EVT versus EVT alone in AIS patients with TLs.MethodsA systematic search was conducted across four databases to identify studies comparing outcomes for patients with TLs receiving IVT prior to EVT with those receiving EVT alone. Outcomes of interest included functional independence (90‐day modified Rankin Scale 0‐2), successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b‐3), 90‐day mortality, and symptomatic intracranial hemorrhage (sICH). We performed a random‐effects meta‐analysis to calculate pooled odds ratios (OR) for each outcome and conducted a sensitivity analysis for patients who underwent acute CAS.ResultsThe analysis included 22 studies with a total of 2,996 patients: 1,678 (56%) received IVT plus EVT and 1,318 (44%) received EVT alone. The results demonstrated that patients treated with IVT before EVT had significantly higher odds of functional independence (IVT+EVT: 52.6% vs. EVT alone: 44.1%; OR=1.34; 95%CI 1.13‐1.59; I2=3%) and successful reperfusion (IVT+EVT: 83.3% vs. EVT alone: 79.8%; OR=1.46; 95%CI 1.16‐1.83; I2=12%). Additionally, the IVT+EVT group had lower odds of 90‐day mortality (IVT+EVT: 13.4% vs. EVT alone: 21.1%; OR=0.61; 95%CI 0.47‐0.78; I2=0%) with no significant increase in sICH risk (IVT+EVT: 8.4% vs. EVT alone: 8.8%; OR=0.90; 95%CI 0.67‐1.21; I2=5%). The sensitivity analysis showed no significant difference in sICH between patients treated with IVT before acute CAS and those who received CAS alone (IVT+CAS: 10.6% vs. CAS alone: 10.9%; OR=0.78; 95%CI 0.44‐1.37; I2=0%).ConclusionOur findings suggest that IVT administered prior to EVT is associated with improved functional outcomes and a higher rate of successful reperfusion in patients with AIS due to TLs. There is also a reduction in 90‐day mortality without a significant increase in sICH risk, even in patients receiving CAS during EVT. These findings support the use of IVT in conjunction with EVT for patients with TLs, although further research is needed to refine antiplatelet treatment protocols and address additional potential risks.
 Ischemia Mortality Sensitivity analysis

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