Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Jan 8;10(1):e0116120.
doi: 10.1371/journal.pone.0116120. eCollection 2015.

Intravenous versus intra-arterial thrombolysis in ischemic stroke: a systematic review and meta-analysis

Qing-feng Ma  1 , Chang-biao Chu  1 , Hai-qing Song  1
Affiliations
Meta-Analysis

Intravenous versus intra-arterial thrombolysis in ischemic stroke: a systematic review and meta-analysis

Qing-feng Ma et al. PLoS One. .

Abstract

Background: Reperfusion following ischemic stroke can be attained by either intravenous thrombolysis (IVT) or intra-arterial thrombolysis (IAT). Only a limited number of randomized prospective studies have compared the efficacy and safety of IVT and IAT. This meta-analysis investigated possible clinical benefits of IAT relative to IVT in patients with acute ischemic stroke.

Methods: We searched the PubMed, Cochrane, and Google Scholar databases through October 2013 for manuscripts that describe the findings of randomized controlled or prospective studies that evaluated the outcomes of patients with ischemic stroke who were treated with IVT or IAT. The clinical outcome measures were score on the modified Rankin scale (mRS) and mortality at 90 days. A favorable outcome was defined as an mRS score of 0 to 2.

Results: For the mRS, the combined odds ratio (OR) of 3.28 (95% confidence interval (CI), 1.91 to 5.65, P < 0.001) indicated that patients who received IAT had a significantly higher chance for a favorable outcome than did those who received IVT. For mortality, the OR indicated that IAT therapy significantly reduced the proportion of patients who died within 90 days of the procedure (combined OR, 0.40; 95%CI, 0.17 to 0.92; P = 0.032).

Conclusion: This meta-analysis determined that IAT conferred a significantly greater probability of achieving a favorable outcome compared with IVT. There was also a significant difference in mortality rates between IAT and IVT. The studies included in this analysis were small and heterogeneous; therefore, larger randomized prospective clinical studies are necessary to further investigate this issue.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. A flow diagram for study selection.
Figure 2
Figure 2. Assessment of the risk of bias among the included studies.
Figure 3
Figure 3. Forest plots showing the results of the meta-analyses.
Figure 4
Figure 4. The results of sensitivity analysis.
(A) Favorable outcome, (B) Mortality.
See this image and copyright information in PMC

References

    1. Bivard A, Lin L, Parsonsb MW (2013) Review of stroke thrombolytics. J Stroke 15: 90–98. 10.5853/jos.2013.15.2.90 - DOI - PMC - PubMed
    1. del Zoppo GJ, Saver JL, Jauch EC, Adams HP Jr (2009) Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke 40: 2945–2948. 10.1161/STROKEAHA.109.192535 - DOI - PMC - PubMed
    1. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, et al. (2012) Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379: 2364–2372. 10.1016/S0140-6736(12)60738-7 - DOI - PMC - PubMed
    1. Endo S, Kuwayama N, Hirashima Y, Akai T, Nishijima M, et al. (1998) Results of urgent thrombolysis in patients with major stroke and atherothrombotic occlusion of the cervical internal carotid artery. AJNR Am J Neuroradiol 19: 1169–1175. - PMC - PubMed
    1. Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, et al. (2007) Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 38: 948–954. 10.1161/01.STR.0000257304.21967.ba - DOI - PubMed

Substances