Comparison between Intra-Arterial Thrombolysis and Intravenous Thrombolysis in Ischemic Stroke Patients: A Meta-Analysis

Abstract

Background: To investigate the efficacy and safety between intra-arterial thrombolysis (IAT) and intravenous thrombolysis (IVT) in ischemic stroke patients. Methods: The full-texts comparing IAT and IVT in ischemic stroke patients were retrieved by PubMed, Embase and Cochrane Central Register of Controlled Trials databases. Review Manager 5.0 was adopted for conducting meta-analysis, sensitivity analysis and bias analysis. Results: A total of 6 studies including 440 patients with ischemic stroke were included. The results of meta-analysis suggested significant differences between IVT and IAT groups in complete recanalization (relative risk (RR) = 0.58, 95% confidence interval (CI) [0.48, 0.71], P < 0.00001; P for Heterogeneity = 0.70, I2 = 0%). But no significant differences were observed in the National Institutes of Health Stroke Scale (NIHSS) after treatment of symptomatic incidence of intracerebral hemorrhage (ICH) and mortality. Conclusions: Our study findings suggested that IAT is more efficient than IVT in direct clinical effects in ischemic stroke patients. Analysis of secondary outcome and safety showed no difference. Additional studies with larger sample sizes are strongly needed to further validate our findings.