ObjectiveTo evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in ischemic stroke, we performed a systematic review and meta-analysis of the literature.MethodsSearches were performed using Medline, Embase, and Cochrane databases for studies that compared EVT to EVT with adjunctive IAT (EVT+IAT). Safety outcomes included symptomatic intracerebral hemorrhage (sICH) and mortality at three months. Efficacy outcomes included successful reperfusion (Thrombolysis in Cerebral Infarction score of 2b to 3), and functional independence, defined as a modified Rankin Scale score of 0 to 2 at three months.ResultsFive studies were identified that compared combined EVT+IAT (IA alteplase or urokinase) to EVT-only, and were included in the random effects meta-analysis. There were 1693 EVT patients, including 269 patients treated with combined EVT+IAT and 1424 patients receiving EVT-only. Pooled analysis did not demonstrate any differences between EVT+IAT and EVT-only in rates of sICH (OR: 0.61, 95% CI: 0.20-1.85; P=0.78), mortality (OR: 0.77, 95% CI: 0.54-1.10; P=0.15), or successful reperfusion (OR: 1.05, 95% CI: 0.52-2.15; P=0.89). There was a higher rate of functional independence in patients treated with EVT+IAT, although this was not statistically significant (OR: 1.34, 95% CI: 1.00-1.80; P=0.053).ConclusionsAdjunctive IAT appears to be safe. In specific situations, neurointerventionists may be justified in administering small doses of intraarterial alteplase or urokinase as rescue therapy during EVT.
Abstract No. 181 Catheter-directed intra-arterial thrombolysis for the management of frostbite injuries: a systematic review
