Compared with endovascular treatment for large-vessel anterior circulation stroke, the combination of intravenous thrombolysis plus endovascular treatment was not shown to be noninferior in a systematic review and individual participant data meta-analysis of 6 trials. The Improving Reperfusion Strategies in Acute Ischaemic Stroke collaboration concludes, “Further research could focus on cost-effectiveness analysis and on individualised decisions when patient characteristics, medication shortages, or delays are expected to offset a potential benefit of administering intravenous thrombolysis before endovascular treatment.”
Based on a primary outcome was the 90-day modified Rankin Scale (mRS) score, the authors report: “We identified 1,081 studies, and six studies (n = 2,313; 1,153 participants randomly assigned to receive endovascular treatment alone and 1,160 randomly assigned to receive intravenous thrombolysis and endovascular treatment) were eligible for analysis. The risk of bias of the included studies was low to moderate. Variability between studies was small, and mainly related to the choice and dose of the thrombolytic drug and country of execution. The median mRS score at 90 days was 3 (IQR 1–5) for participants who received endovascular treatment alone and 2 (1–4) for participants who received intravenous thrombolysis plus endovascular treatment ([adjusted common odds ratio] 0.89, 95% CI 0.76–1.04). Any intracranial haemorrhage (0.82, 0.68–0.99) occurred less frequently with endovascular treatment alone than with intravenous thrombolysis plus endovascular treatment. Symptomatic intracranial haemorrhage and mortality rates did not differ significantly.”