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May 9, 2018

Europe Stroke Organisation Conference

DIRECT ENDOVASCULAR TREATMENT VERSUS INTRAVENOUS RTPA FOLLOWED BY ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

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LeCouffe, N.E.;

Kappelhof, M.;

Treurniet, K.M.;

Marquering, H.A.;

Majoie, C.B.L.M.;

Roos, Y.B.W.E.M.;

Coutinho, J.M.

acute ischemic stroke

endovascular treatment

intravenous thrombolysis

direct evt

Abstract

Abstract

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Keywords

acute ischemic stroke

endovascular treatment

intravenous thrombolysis

direct evt

Abstract

DIRECT ENDOVASCULAR TREATMENT VERSUS INTRAVENOUS RTPA FOLLOWED BY ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS N.E. LeCouffe1, M. Kappelhof2, K.M. Treurniet2, H.A. Marquering3, C.B.L.M. Majoie2, Y.B.W.E.M. Roos1, J.M. Coutinho1. 1Academic Medical Center, Neurology, Amsterdam, The Netherlands. 2Academic Medical Center, Radiology and Nuclear Medicine, Amsterdam, The Netherlands. 3Academic Medical Center, Radiology and Nuclear Medicine- Biomedical Engineering and Physics, Amsterdam, The Netherlands. Background and Aims: Endovascular treatment (EVT) has become standard-of-care for acute ischaemic stroke caused by proximal anterior circulation occlusions. The additional benefit of intravenous thrombolysis (IVT) in patients undergoing EVT is being debated. Methods: We conducted a systematic review and meta-analysis comparing IVT+EVT to direct EVT. We included studies with ≥10 patients, that used 2nd generation devices, and performed multivariable analyses. Our primary outcome was functional independence (modified Rankin Scale score [mRS] 0-2) at 90 days. Safety outcomes included symptomatic intracranial haemorrhage (sICH). We applied a fixed effects model. Results: Out of 4.007 search results, we included 24 studies with data of 5770 patients (2260 direct EVT). All studies had an observational design (20 retrospective). Four studies reported on direct EVT in patients without contraindications for IVT. In the unadjusted analysis, IVT+EVT was associated with a higher likelihood of functional independence than direct EVT (summary OR [sOR] 1.49,95%CI 1.32-1.67). In the analysis with adjusted ORs, the effect estimate lost statistical significance (sOR 1.14, 95%CI 0.94-1.39). In the analysis of studies including only patients without IVT contraindications, the point estimate reversed and indicated better outcomes in the direct EVT group (sOR 0.86, 95%CI 0.62-1.19). There was a trend of increased sICH risk in the IVT+EVT group in both the unadjusted analysis (sOR 1.17, 95%CI 0.88-1.56) and subgroup without IVT contraindications (sOR 1.52, 95%CI 0.90-2.57). Conclusion: Better outcomes after IVT+EVT compared to direct EVT observed in non-randomized studies may be explained by residual confounding. Randomized trials are needed.

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© Copyright 2019 Morressier GmbH.
All rights reserved.