Intra-arterial thrombolysis after successful endovascular reperfusion for large vessel occlusion stroke: A meta-analysis of randomized seven controlled trials
Notice bibliographique
Résumé
Background Although thrombectomy is the standard of care for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO), many patients fail to achieve disability-free recovery, highlighting the need for adjunctive therapy to improve outcomes. Purpose This systematic review and meta-analysis aimed to compare intra-arterial thrombolysis (IAT) and placebo following the successful recanalization of AIS-LVO. Materials and Methods A systematic literature review of four databases was performed. Categorical and continuous outcomes were calculated using Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs), respectively. Any potential heterogeneity was resolved through leave-one-out influence analysis. Risk of bias was assessed using the RoB2 tool. Our study was not registered in PROSPERO. The primary analysis included three published RCTs; four additional trials, including posterior circulation or preliminary data, were incorporated in sensitivity analyses to validate robustness. Results A total of three trials with enrolled patients 1187 were included in the study. Four additional trials were also included only for sensitivity analysis. The findings showed that patients who received IAT had a significantly higher rate of 90-day functional excellence (RR = 1.15, 95%CI = 1.01–1.3, P = .032, I 2 = 0.0%) than the control group. There was no significant difference between the two groups regarding functional independence, mortality, symptomatic or any intracranial hemorrhage, and total adverse events. There was a significantly higher functional excellence rate in IAT group compared with control group in studies that included patients with expanded thrombolysis in cerebral infarction score (eTICI) score of 2b-3 versus 2c-3 (RR = 1.5, 95%CI = 1.23–1.82 P = .016, I 2 = 0.0%) and female patients derived more benefit from IAT than placebo (RR = 1.42, 95%CI = 1.15–1.75, P = .001, I 2 = 0.0%). Notably, there was no significant heterogeneity across any primary and secondary outcomes. Conclusion In patients with AIS-LVO presenting within 24 h of time last seen well who achieved successful endovascular recanalization, IAT significantly improved the likelihood of functional excellence at three months without hemorrhagic risk. Further research is warranted to validate these findings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,047 | 0,075 |
| Bibliométrie | 0,003 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».