医学
溶栓
改良兰金量表
相对风险
内科学
随机对照试验
冲程(发动机)
置信区间
荟萃分析
组织纤溶酶原激活剂
急性中风
纤溶剂
血运重建
外科
缺血性中风
心肌梗塞
缺血
机械工程
工程类
作者
Shingo Matsumoto,Takahisa Mikami,Masao Iwagami,Alexandros Briasoulis,Takanori Ikeda,Hisato Takagi,Toshiki Kuno
标识
DOI:10.1016/j.jstrokecerebrovasdis.2022.106491
摘要
The benefit and risk of administration of tissue plasminogen activator (tPA) before endovascular mechanical thrombectomy (E-MT) in acute stroke has been actively debated. We therefore aimed to investigate the efficacy and safety of three therapeutic strategies for acute stroke: direct E-MT, E-MT with pre-administration of tPA, and tPA alone with a network meta-analysis.PUBMED and EMBASE were searched from September to November 2021 for randomized control trials that compared direct E-MT, E-MT with tPA, and tPA alone therapies in acute stroke. The primary outcome was functional independence, defined as modified Rankin Scale score of 0-2, at 90 days. All-cause mortality, symptomatic intracranial hemorrhage, and successful revascularization were also evaluated.We identified 11 randomized controlled trials with a total of 3,640 patients with acute stroke. Compared to E-MT with tPA, direct E-MT provided comparable outcomes regarding functional independence (relative risk (RR): 1.02; 95% confidence interval (CI): 0.88-1.19, I2 = 36.6%) and all-cause mortality (RR: 1.05; 95% CI: 0.85-1.31, I2 = 0%). The incidence of symptomatic intracranial hemorrhage was not significantly different between direct E-MT and E-MT with tPA (RR: 0.83; 95% CI: 0.57-1.20, I2 = 0%). Direct E-MT had favorable functional independence (RR: 1.41; 95% CI: 1.15-1.74, I2 = 36.6%) and higher successful revascularization rate (RR: 1.60; 95% CI: 1.33-1.93, I2 = 61.2%) than tPA alone.Direct E-MT alone led to acceptable outcomes even in comparison to E-MT with tPA, whereas additional tPA did not cause higher risk of symptomatic intracranial hemorrhage.
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