SynthesisStroke and vascular neurology2022
Endovascular thrombectomy with or without intravenous alteplase for acute ischemic stroke due to large vessel occlusion: a systematic review and meta-analysis of randomized trials.
Synthesis in Stroke and vascular neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- Meta-Analysis of the Safety and Efficacy of Intensive Blood Pressure Control After Thrombectomy.Brain and behavior · 2025Pooled it
- Real-world setting comparison of bridging therapy versus direct mechanical thrombectomy for acute ischemic stroke: A meta-analysis.Clinics (Sao Paulo, Brazil) · 2024Pooled it
- Intensive versus standard blood pressure management after endovascular therapy in acute ischemic stroke: a systematic review and meta-analysis.Annals of medicine and surgery (2012) · 2026Article
- Impacts of neurointerventional therapy combined with intravenous thrombolysis on neurological function, oxidative stress, and immune function in patients with acute ischemic stroke.Frontiers in medicine · 2026Article
- Risk of Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy in Randomized Clinical Trials: A Systematic Review and Meta-Analysis.Brain sciences · 2025Review
- Exploring the impact of intensive versus standard blood pressure management following post-endovascular therapy in ischemic stroke: A comparative systematic review and meta-analysis.Qatar medical journal · 2025Article
- The role of ASPECTS score, atrial fibrillation, and revascularization therapy in predicting hemorrhagic transformation of ischemic stroke: results from a prospective cohort study.Frontiers in neurology · 2025Article
- When treating acute ischaemic stroke of LVO type, time window prevails over tissue window.Stroke and vascular neurology · 2024Article
- Blood pressure management after endovascular thrombectomy: Insights of recent randomized controlled trials.CNS neuroscience & therapeutics · 2024Review
- Predictors of futile recanalization in nonagenarians treated with mechanical thrombectomy: a multi-center observational study.Journal of neurology · 2024Observational
- Introducing the Futile Recanalization Prediction Score (FRPS): A Novel Approach to Predict and Mitigate Ineffective Recanalization after Endovascular Treatment of Acute Ischemic Stroke.Neurology international · 2024Article
- Endovascular Thrombectomy With or Without Thrombolysis for Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.The Neurohospitalist · 2024Article
- Article
- Endovascular Thrombectomy for Large Ischemic Strokes: A Living Systematic Review and Meta-Analysis of Randomized Trials.Journal of stroke · 2023Review
- Endovascular Thrombectomy with or without Intravenous Thrombolysis for Anterior Circulation Large Vessel Occlusion in the Imperial College London Thrombectomy Registry.Journal of clinical medicine · 2023Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAmong patients who had an ischaemic stroke presenting directly to a stroke centre where endovascular thrombectomy (EVT) is immediately available, there is uncertainty regarding the role of intravenous thrombolysis agents before or concurrently with EVT. To support a rapid guideline, we conducted a systematic review and meta-analysis to examine the impact of EVT alone versus EVT with intravenous alteplase in patients who had an acute ischaemic stroke due to large vessel occlusion.
methodsIn November 2021, we searched MEDLINE, Embase, PubMed, Cochrane, Web of Science, clincialtrials.gov and the ISRCTN registry for randomised controlled trials (RCTs) comparing EVT alone versus EVT with alteplase for acute ischaemic stroke. We conducted meta-analyses using fixed effects models and assessed the certainty of evidence using the GRADE approach.
resultsIn total 6 RCTs including 2334 participants were eligible. Low certainty evidence suggests that, compared with EVT and alteplase, there is possibly a small decrease in the proportion of patients independent with EVT alone (risk ratio (RR) 0.97, 95% CI 0.89 to 1.05; risk difference (RD) -1.5%; 95% CI -5.4% to 2.5%), and possibly a small increase in mortality with EVT alone (RR 1.07, 95% CI 0.88 to 1.29; RD 1.2%, 95% CI -2.0% to 4.9%) . Moderate certainty evidence suggests that there is probably a small decrease in symptomatic intracranial haemorrhage (sICH) with EVT alone (RR 0.75, 95% CI 0.52 to 1.07; RD -1.0%; 95%CI -1.8% to 0.27%).
conclusionsLow certainty evidence suggests that there is possibly a small decrease in the proportion of patients that achieve functional independence and a small increase in mortality with EVT alone. Moderate certainty evidence suggests that there is probably a small decrease in sICH with EVT alone. The accompanying guideline provides contextualised guidance based on this body of evidence. PROSPERO REGISTRATION NUMBER: CRD42021249873.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.