School of Medicine Publications and Presentations
Document Type
Article
Publication Date
9-2025
Abstract
Background: The safety and efficacy of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in acute ischemic stroke remain uncertain.
Methods: We comprehensively searched PubMed, Embase, and the Cochrane Library from inception to May 30, 2025. Randomized controlled trials comparing IVT before MT versus MT alone in acute ischemic stroke were included. The primary outcome was excellent functional outcome (modified Rankin Scale score 0–1 at 90 days) and good functional outcome (modif ied Rankin Scale score 0–2). Secondary outcomes included successful recanalization, all-cause death, symptomatic, and any intracranial hemorrhage. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.
Results: Seven randomized controlled trials encompassing 2884 patients (MT+IVT: 1448; MT–IVT: 1436) met the inclusion criteria. The pooled analysis demonstrated comparable results for excellent functional outcome (31.3% vs. 29.5%; OR, 1.08 [95% CI, 0.92–1.28]), good functional outcome (51.2% vs. 48.0%; OR, 1.13 [95% CI, 0.96–1.34]) between the MT+ IVT and MT alone groups, respectively. Rates of successful recanalization (OR, 1.24 [95% CI, 0.95–1.62]), all-cause death (OR, 0.98 [95% CI, 0.80–1.19]), symptomatic intracranial hemorrhage (OR, 1.21 [95% CI, 0.87–1.68]), and any intracranial hemorrhage (OR, 1.17 [95% CI, 0.97–1.41]) were also comparable between the two groups. Trial sequential analysis demonstrated insufficient evidence to confirm a 20% relative benefit of bridging therapy compared to MT alone.
Conclusion: In this study-level meta-analysis, IVT followed by endovascular treatment showed comparable safety and efficacy to endovascular treatment alone, with similar outcomes in functional recovery, successful recanalization, all-cause mortality, symptomatic intracranial hemorrhage, and any intracranial hemorrhage.
Recommended Citation
Hashmi, T. M., Ahmed, M., Ashraf, H., Shakir, M., Bhatti, I. A., Alareed, A., Ahmed, F., Hasan, A., Ahmed, R., Aized, M. T., Rafiq, S., Fonarow, G. C., & Hassan, A. E. (2025). Efficacy and safety of bridging intravenous thrombolysis before mechanical thrombectomy in acute ischemic stroke: A systematic review and meta-analysis. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 15910199251368728. Advance online publication. https://doi.org/10.1177/15910199251368728
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publication Title
Interventional Neuroradiology
DOI
10.1177/15910199251368728
Academic Level
faculty
Mentor/PI Department
Neurology
Comments
© The Author(s) 2025