IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy: A Systematic Review and Meta-analysis.

Neurology

From the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.

Published: April 2023

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.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10104605PMC
http://dx.doi.org/10.1212/WNL.0000000000206784DOI Listing

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