The Effectiveness and Safety of Mechanical Thrombectomy Compared with Thrombolytic Therapy in Acute Stroke: A Systematic Review and Meta-Analysis

Abstract

Background: This study aims to investigate the effectiveness of mechanical thrombectomy compared with thrombolytic therapy in patients with acute stroke. Methods: This study is a systematic review on clinical studies, as the Cochrane library, PubMed, Google Scholar, Web of Science, and Embase databases were searched. The time span selected to retrieve articles is 1990 to 2017. The quality of the articles found was evaluated by the CONSORT checklist. Fixed effects and random effects models were employed for meta-analysis. Results were subject to sensitivity analysis in specified curtained interval, CMA (Comprehensive Meta-Analysis software): 2 software was used to carry out the meta-analysis task, and alpha was set to 5%. Results: The eight papers found met the inclusion criteria. Patients in mechanical thrombectomy group had a significantly higher improvement rate compared to the thrombolytic therapy group [OR 1.71 (1.182.48), P = 0.005]. There were no significant differences between mechanical thrombectomy and thrombolytic therapy groups regarding intracerebral hemorrhage ([OR 1.03 (0.71 - 1.49), P = 0.88]). Mechanical thrombectomy was more effective in reducing mortality rate of patients, however, this difference was not significant ([OR 0.84 (0.67 - 1.05), P = 0.12]). The effectiveness of mechanical thrombectomy is superior to thrombolytic therapy based on the improvement rate, 90-day mortality and symptoms of intracerebral hemorrhage OR: 2.23 (1.77 - 2.81), P < 0.00001; OR 0.79 (0.60 - 1.05), P = 0.10, and OR 1.02 (0.61 - 1.70), P = 0.95, respectively. Conclusions: Through some good criteria for selecting appropriate patients, mechanical thrombectomy can be superior to thrombolytic therapy in patients with acute stroke.

Keywords

• Acute Stroke
• Mechanical Thrombectomy
• Thrombolytic Therapy
• Meta-analysis