Abstract Number ‐ 176: Mechanical thrombectomy with or without bridging in stroke: A systematic review and meta‐analysis of RCTs
Bibliographic record
Abstract
Introduction Current published guidelines and meta‐analyses comparing direct mechanical thrombectomy (MT) alone versus MT with bridging intravenous thrombolysis (IVT) suggested that MT alone is non‐inferior to MT with bridging thrombolysis in achieving favorable functional outcome. Because of this controversy, we aimed to systematically update the evidence and meta‐analyze data from randomized trials comparing MT alone versus MT with bridging thrombolysis. Methods We searched MEDLINE (through Ovid), EMBASE, and the Cochrane Library from inception to December 14, 2021 without any language restrictions to identify randomized controlled trials (RCTs) and post‐hoc analyses of RCTs comparing direct MT with or without bridging IVT in patients presenting with acute ischemic stroke secondary to a large vessel occlusion. We conducted meta‐analyses using random‐effects models to compare the rates for favorable functional outcome (defined as modified Rankin scale [mRS] score of 0 to 2) and mortality at 90 days, and symptomatic intracranial hemorrhage (sICH), between MT and MT with IVT. We also assessed the risk of bias using the Cochrane risk‐of‐bias tool (RoB) and the certainty of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Of 11,111 citations, we identified 53 eligible studies, and included 8 studies with a total of 3,008 participants. We found low‐certainty evidence suggesting that there is probably a small increase in the proportion of patients with favorable functional outcome with an mRS of 0 to 2 at 90 days for those who underwent MT with IVT compared to those with MT alone (risk ratio [RR] 1.08, 95% CI 0.99 to 1.19); moderate‐certainty evidence that there is probably a small decrease in mortality at 90 days for patients with MT plus IVT compared to MT alone (RR 0.86, 95% CI 0.71 to 1.03); and very low‐certainty evidence that there is possibly an increase in sICH for patients with MT plus IVT compared to MT alone (RR 1.17, 95% CI 0.85 to 1.61). When we restricted the analyses to RCTs only, we found no significant differences in favorable functional outcome (RR 2.05, 95% CI 0.97 to 1.13), mortality (RR 0.94, 95% CI 0.78 to 1.14), or sICH (RR 1.20, 95% CI 0.85 to 1.70). Conclusions Low‐certainty evidence shows that there is probably a small increase in the proportion of patients with favorable functional outcome, moderate‐certainty evidence shows that there is probably a small decrease in mortality, and very low‐certainty evidence that there is possibly an increase in sICH for patients with MT plus IVT compared to MT alone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.094 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.038 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".