Intravenous Thrombolysis before versus Direct Endovascular Treatment for Acute Ischemic Stroke due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis.
Cerebrovascular diseases (Basel, Switzerland) · 2026-06-18 · Meta-analysis
Abstract
INTRODUCTION: This study aimed to evaluate the potential efficacy of bridging intravenous thrombolysis (IVT) before endovascular treatment (EVT) in patients with large vessel occlusion (LVO). METHODS: We systematically searched PubMed, <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, Cochrane Library, and Web of Science up to December 1, 2025 to identify randomized controlled trials (RCTs) comparing IVT plus EVT with EVT alone at guideline-recommended doses. The primary outcome was functional independence at 90 days (modified Rankin scale [mRS] score 0-2). Pooled risk ratios (RRs) with 95% confidence intervals (CI) were calculated using a random effects model, with subgroup analyses conducted by thrombolytic agent. RESULTS: Six RCTs comprising 2,680 patients were included. Compared to EVT alone, IVT plus EVT may be associated with a higher likelihood of functional independence (RR 1.08, 95% CI 1.00-1.17; p = 0.04). Subgroup analysis showed a significant benefit of functional independence with tenecteplase (RR 1.22, 95% CI 1.03-1.44; p = 0.02) but not with alteplase (RR 1.04, 95% CI 0.96-1.14; p = 0.35). Moreover, IVT plus EVT was associated with a higher likelihood of successful recanalization before EVT (RR, 2.38; 95% CI, 1.38-4.12; p = 0.002). The safety outcomes demonstrated that no evidence of a difference was observed between the IVT plus EVT and EVT alone groups. CONCLUSION: IVT plus EVT may be associated with higher likelihood of functional independence and early recanalization in LVO patients. However, these findings require confirmation in larger RCTs.
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Tags
Antithrombotics & thrombolytics · Mortality & survival · Quality of life & function · Thrombolytics
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