PT  - JOURNAL ARTICLE
AU  - Wang, Xin
AU  - Ye, Zhikang
AU  - Busse, Jason W
AU  - Hill, Michael D
AU  - Smith, Eric E
AU  - Guyatt, Gordon H
AU  - Prasad, Kameshwar
AU  - Lindsay, M Patrice
AU  - Yang, Hui
AU  - Zhang, Yi
AU  - Liu, Ying
AU  - Tang, Borui
AU  - Wang, Xinrui
AU  - Wang, Yushu
AU  - Couban, Rachel J
AU  - An, Zhuoling
TI  - Endovascular thrombectomy with or without intravenous alteplase for acute ischemic stroke due to large vessel occlusion: a systematic review and meta-analysis of randomized trials
AID  - 10.1136/svn-2022-001547
DP  - 2022 Jun 20
TA  - Stroke and Vascular Neurology
PG  - svn-2022-001547
4099  - http://svn.bmj.com/content/early/2022/06/20/svn-2022-001547.short
4100  - http://svn.bmj.com/content/early/2022/06/20/svn-2022-001547.full
AB  - Background Among patients who had an ischaemic stroke presenting directly to a stroke centre where endovascular thrombectomy (EVT) is immediately available, there is uncertainty regarding the role of intravenous thrombolysis agents before or concurrently with EVT. To support a rapid guideline, we conducted a systematic review and meta-analysis to examine the impact of EVT alone versus EVT with intravenous alteplase in patients who had an acute ischaemic stroke due to large vessel occlusion.Methods In November 2021, we searched MEDLINE, Embase, PubMed, Cochrane, Web of Science, clincialtrials.gov and the ISRCTN registry for randomised controlled trials (RCTs) comparing EVT alone versus EVT with alteplase for acute ischaemic stroke. We conducted meta-analyses using fixed effects models and assessed the certainty of evidence using the GRADE approach.Results In total 6 RCTs including 2334 participants were eligible. Low certainty evidence suggests that, compared with EVT and alteplase, there is possibly a small decrease in the proportion of patients independent with EVT alone (risk ratio (RR) 0.97, 95% CI 0.89 to 1.05; risk difference (RD) −1.5%; 95% CI −5.4% to 2.5%), and possibly a small increase in mortality with EVT alone (RR 1.07, 95% CI 0.88 to 1.29; RD 1.2%, 95% CI −2.0% to 4.9%) . Moderate certainty evidence suggests that there is probably a small decrease in symptomatic intracranial haemorrhage (sICH) with EVT alone (RR 0.75, 95% CI 0.52 to 1.07; RD −1.0%; 95%CI −1.8% to 0.27%).Conclusions Low certainty evidence suggests that there is possibly a small decrease in the proportion of patients that achieve functional independence and a small increase in mortality with EVT alone. Moderate certainty evidence suggests that there is probably a small decrease in sICH with EVT alone. The accompanying guideline provides contextualised guidance based on this body of evidence.PROSPERO registration number CRD42021249873.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.