Abstract：
OBJECTIVE: The benefit and safety of intravenous thrombolysis before endovascular thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion (BAO) remains unclear. This article aims to investigate the clinical outcomes and safety of endovascular thrombectomy with versus without intravenous thrombolysis in acute BAO stroke patients.
METHODS: We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases to identify relevant literature pertaining to patients with acute BAO who underwent endovascular thrombectomy alone or intravenous thrombolysis bridging with endovascular thrombectomy (bridging therapy), until January 10, 2024. The primary outcome was functional independence, defined as a score of 0-2 on the modified Rankin Scale at 90 days. The safety outcome was mortality at 90 days and symptomatic intracranial hemorrhage within 48 h. Effect sizes were computed as risk ratio (RR) with random-effect models. This study was registered in PROSPERO (CRD42023462293).
RESULTS: A total of 528 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded. Finally, 2 RCTs and 10 cohort studies met the inclusion criteria. The findings revealed that the endovascular thrombectomy alone group had a lower rate of functional independence compared to the bridging therapy group (29% vs 38%; RR 0.78, 95% CI 0.68-0.88, p < 0.001), lower independent ambulation (39% vs 45%; RR 0.89, 95% CI 0.82-0.98, p = 0.01), and higher mortality (36% vs 28%, RR 1.22, 95% CI 1.08-1.37, p = 0.001). However, no differences were detected in symptomatic intracranial hemorrhage between the two groups (6% vs 4%; RR 1.12, 95% CI 0.74-1.71, p = 0.58).
CONCLUSIONS: Intravenous thrombolysis plus endovascular thrombectomy seemed to led to better functional independence, independent ambulation, and lower risk of mortality without increasing the incidence of intracranial hemorrhage compared to endovascular thrombectomy alone. However, given the non-randomized nature of this study, further studies are needed to confirm these findings.
METHODS: We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases to identify relevant literature pertaining to patients with acute BAO who underwent endovascular thrombectomy alone or intravenous thrombolysis bridging with endovascular thrombectomy (bridging therapy), until January 10, 2024. The primary outcome was functional independence, defined as a score of 0-2 on the modified Rankin Scale at 90 days. The safety outcome was mortality at 90 days and symptomatic intracranial hemorrhage within 48 h. Effect sizes were computed as risk ratio (RR) with random-effect models. This study was registered in PROSPERO (CRD42023462293).
RESULTS: A total of 528 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded. Finally, 2 RCTs and 10 cohort studies met the inclusion criteria. The findings revealed that the endovascular thrombectomy alone group had a lower rate of functional independence compared to the bridging therapy group (29% vs 38%; RR 0.78, 95% CI 0.68-0.88, p < 0.001), lower independent ambulation (39% vs 45%; RR 0.89, 95% CI 0.82-0.98, p = 0.01), and higher mortality (36% vs 28%, RR 1.22, 95% CI 1.08-1.37, p = 0.001). However, no differences were detected in symptomatic intracranial hemorrhage between the two groups (6% vs 4%; RR 1.12, 95% CI 0.74-1.71, p = 0.58).
CONCLUSIONS: Intravenous thrombolysis plus endovascular thrombectomy seemed to led to better functional independence, independent ambulation, and lower risk of mortality without increasing the incidence of intracranial hemorrhage compared to endovascular thrombectomy alone. However, given the non-randomized nature of this study, further studies are needed to confirm these findings.
摘要：
目的：基底动脉闭塞（BAO）所致急性缺血性卒中患者腔内取栓前静脉溶栓的益处和安全性尚不清楚。本文旨在探讨血管内取栓联合静脉溶栓治疗急性BAO卒中患者的临床疗效和安全性。
方法：我们对PubMed进行了全面搜索，Embase,科克伦,和WebofScience数据库，以确定与急性BAO患者相关的文献，这些患者仅接受血管内血栓切除术或静脉溶栓桥接血管内血栓切除术（桥接治疗），直到2024年1月10日。主要结果是功能独立，定义为90天时改良的Rankin量表评分为0-2分。安全性结果为90天的死亡率和48小时内的症状性颅内出血。使用随机效应模型计算效应大小作为风险比（RR）。本研究在PROSPERO(CRD42023462293)中注册。
结果：通过检索共获得528篇文章，排除不符合纳入标准的文章。最后,2项随机对照试验和10项队列研究符合纳入标准。结果显示，与桥接治疗组相比，单独血管内血栓切除术组的功能独立性较低（29％vs38％；RR0.78，95％CI0.68-0.88，p<0.001），较低的独立下床活动(39%vs45%；RR0.89，95%CI0.82-0.98，p=0.01)，和更高的死亡率(36%对28%，RR1.22，95%CI1.08-1.37，p=0.001）。然而,两组间症状性颅内出血无差异(6%vs4%;RR1.12,95%CI0.74-1.71,p=0.58).
结论：静脉溶栓加血管内血栓切除术似乎导致更好的功能独立性，独立行走，与单纯血管内血栓切除术相比，在不增加颅内出血发生率的情况下，死亡率风险较低。然而,鉴于这项研究的非随机性质，需要进一步的研究来证实这些发现.
方法：我们对PubMed进行了全面搜索，Embase,科克伦,和WebofScience数据库，以确定与急性BAO患者相关的文献，这些患者仅接受血管内血栓切除术或静脉溶栓桥接血管内血栓切除术（桥接治疗），直到2024年1月10日。主要结果是功能独立，定义为90天时改良的Rankin量表评分为0-2分。安全性结果为90天的死亡率和48小时内的症状性颅内出血。使用随机效应模型计算效应大小作为风险比（RR）。本研究在PROSPERO(CRD42023462293)中注册。
结果：通过检索共获得528篇文章，排除不符合纳入标准的文章。最后,2项随机对照试验和10项队列研究符合纳入标准。结果显示，与桥接治疗组相比，单独血管内血栓切除术组的功能独立性较低（29％vs38％；RR0.78，95％CI0.68-0.88，p<0.001），较低的独立下床活动(39%vs45%；RR0.89，95%CI0.82-0.98，p=0.01)，和更高的死亡率(36%对28%，RR1.22，95%CI1.08-1.37，p=0.001）。然而,两组间症状性颅内出血无差异(6%vs4%;RR1.12,95%CI0.74-1.71,p=0.58).
结论：静脉溶栓加血管内血栓切除术似乎导致更好的功能独立性，独立行走，与单纯血管内血栓切除术相比，在不增加颅内出血发生率的情况下，死亡率风险较低。然而,鉴于这项研究的非随机性质，需要进一步的研究来证实这些发现.
