Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data.

Kaesmacher, Johannes; Meinel, Thomas Raphael; Kurmann, Christoph; Zaidat, Osama O; Castonguay, Alicia C; Zaidi, Syed F; Mueller-Kronast, Nils; Kappelhof, Manon; Dippel, Diederik W J; Soudant, Marc; Bracard, Serge; Hill, Michael D; Goyal, Mayank; Strbian, Daniel; Heiferman, Daniel M; Ashley, William; Anadani, Mohammad; Spiotta, Alejandro M; Dobrocky, Tomas; Piechowiak, Eike I.; ... (2021). Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data. Journal of neurointerventional surgery, 13(12), pp. 1073-1080. BMJ Publishing Group 10.1136/neurintsurg-2020-016680

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BACKGROUND

Achieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse.

METHODS

We performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin Scale ≤2, mortality at 90 days).

RESULTS

The search identified six observational cohort studies and three observational datasets of MT randomized-controlled trial data reporting on IA fibrinolytics with MT as compared with MT alone, including 2797 patients (405 with additional IA fibrinolytics (100 urokinase (uPA), 305 tissue plasminogen activator (tPA)) and 2392 patients without IA fibrinolytics). Of 405 MT patients treated with additional IA fibrinolytics, 209 (51.6%) received prior intravenous tPA. We did not observe an increased risk of sICH after administration of IA fibrinolytics as adjunct to MT (OR 1.06, 95% CI 0.64 to 1.76), nor excess mortality (0.81, 95% CI 0.60 to 1.08). Although the mode of reporting was heterogeneous, some studies observed improved reperfusion after IA fibrinolytics.

CONCLUSION

The quality of evidence regarding peri-interventional administration of IA fibrinolytics in MT is low and limited to observational data. In highly selected patients, no increase in sICH was observed, but there is large uncertainty.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Kaesmacher, Johannes; Meinel, Thomas Raphael; Kurmann, Christoph Carmelino; Dobrocky, Tomas; Piechowiak, Eike Immo; Arnold, Marcel; Göldlin, Martina Béatrice; Seiffge, David Julian; Mosimann, Pascal John; Mordasini, Pasquale; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

16 Feb 2021 08:22

Last Modified:

21 Nov 2021 00:11

Publisher DOI:

10.1136/neurintsurg-2020-016680

PubMed ID:

33514609

Uncontrolled Keywords:

stroke thrombectomy thrombolysis

BORIS DOI:

10.48350/151734

URI:

https://boris.unibe.ch/id/eprint/151734

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