SynthesisStroke2018
Successful Reperfusion With Intravenous Thrombolysis Preceding Mechanical Thrombectomy in Large-Vessel Occlusions.
Abstract readMeta-AnalysisMulticenter StudySystematic Review
In one paragraph
Synthesis in Stroke, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 15 of them syntheses that pooled it.
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78citing papers in PubMed, 15 pooled it
–field-weighted citation impact
What it found
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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
78 citing papers in PubMed, 15 syntheses or guidelines pooled it.
- Mechanical thrombectomy alone versus with thrombolysis for ischemic stroke: A meta-analysis of randomized trials.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026Pooled it
- Endovascular thrombectomy with versus without intravenous thrombolysis for acute ischaemic stroke.The Cochrane database of systematic reviews · 2025Pooled it
- Bridging therapy versus direct mechanical thrombectomy in acute ischemic stroke: an updated meta-analysis of real-world evidence.Frontiers in medicine · 2025Pooled it
- Risk of Hemorrhagic Transformation after Mechanical Thrombectomy without versus with IV Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Clinical Trials.AJNR. American journal of neuroradiology · 2024Pooled it
- Intravenous thrombolysis plus mechanical thrombectomy versus mechanical thrombectomy alone for acute ischemic stroke: A systematic review and updated meta-analysis of clinical trials.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2024Pooled it
- Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial.Journal of neurointerventional surgery · 2023Pooled it
- IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy: A Systematic Review and Meta-analysis.Neurology · 2023Pooled it
- 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.Stroke and vascular neurology · 2022Pooled it
- Efficacy and safety of endovascular treatment with or without intravenous alteplase in acute anterior circulation large vessel occlusion stroke: a meta-analysis of randomized controlled trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022Pooled it
- Endovascular thrombectomy without versus with intravenous thrombolysis in acute ischemic stroke: a non-inferiority meta-analysis of randomized clinical trials.Journal of neurointerventional surgery · 2022Pooled it
- Stroke network performance during the first COVID-19 pandemic stage: A meta-analysis based on stroke network models.International journal of stroke : official journal of the International Stroke Society · 2021Pooled it
- Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2021Pooled it
- Comparison of Prior Bridging Intravenous Thrombolysis With Direct Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion: Systematic Review and Meta-Analysis.Frontiers in neurology · 2021Pooled it
- Endovascular Treatment With and Without Intravenous Thrombolysis in Large Vessel Occlusions Stroke: A Systematic Review and Meta-Analysis.Frontiers in neurology · 2021Pooled it
- Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis.Journal of neurointerventional surgery · 2019Pooled it
- Outcome and Risk of Poststroke Pneumonia in Patients with Acute Ischemic Stroke After Endovascular Thrombectomy: A Post Hoc Analysis of the DIRECT-MT Trial.Neurocritical care · 2024Trial
- Cost-effective analysis of mechanical thrombectomy alone in the treatment of acute ischaemic stroke: a Markov modelling study.BMJ open · 2022Trial
- Relationships between brain perfusion and early recanalization after intravenous thrombolysis for acute stroke with large vessel occlusion.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2020Trial
- Trial
- Article
18 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Georgios TsivgoulisFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.). tsivgoulisgiorg@yahoo.gr.
Aristeidis H KatsanosFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Peter D SchellingerFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Martin KöhrmannFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Panayiotis VarelasFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Georgios MagoufisFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Maurizio PaciaroniFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Valeria CasoFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Anne W AlexandrovFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Edip GurolFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Andrei V AlexandrovFrom the Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K.); Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T., A.W.A., A.V.A.); Department of Neurology, University of Ioannina, Greece (A.H.K.); Department of Neurology (P.D.S.) and Department of Neurogeriatry (P.D.S.), Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany; Department of Neurology, Universitätsklinikum Essen, Germany (M.K.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V.); Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece (G.M.); Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (M.P., V.C.); and J.P. Kistler Stroke Research Center, Massachusetts General Hospital, Boston (E.G.).
Funding
Molecular Neuroimaging of Disease Mechanisms in Cerebral Amyloid AngiopathyK23NS083711 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI GUROL, MAHMUT EDIP · 2014 to 2018
$988kNINDS NIH HHS K23 NS083711
Abstract
background and purposeAlthough current guidelines advocate pretreatment with intravenous thrombolysis (IVT) in all eligible patients with acute ischemic stroke with large-vessel occlusion before mechanical thrombectomy, there are observational data questioning the efficacy of this approach. One of the main arguments in favor of IVT pretreatment is the potential for tissue-type plasminogen activator-induced successful reperfusion (SR) before the onset of endovascular procedure.
methodsWe performed a systematic review and meta-analysis of randomized controlled clinical trials and observational cohorts providing rates of SR with IVT in patients with large-vessel occlusion before the initiation of mechanical thrombectomy. We also performed subgroup analyses according to study type (randomized controlled clinical trials versus observational) and according to the inclusion per protocol of patients with tandem (intracranial/extracranial) occlusions.
resultsWe identified 13 eligible studies (7 randomized controlled clinical trials and 6 observational cohorts), including 1561 patients with acute ischemic stroke (median National Institutes of Health Stroke Scale score, 17) with large-vessel occlusion. SR following IVT and before mechanical thrombectomy was documented in 11% (95% confidence interval, 7%-16%), with no difference among cohorts derived from randomized controlled clinical trials and observational studies. There was significant heterogeneity across included studies both in the overall analysis and among subgroups (I
conclusionsPretreatment with systemic thrombolysis in patients with large-vessel occlusion eligible for mechanical thrombectomy results in SR in 1 of 10 cases, negating the need for additional endovascular reperfusion. Tandem occlusions seem to be the least responsive to IVT pretreatment.
Indexed as
Brain IschemiaCerebral VeinsEndovascular ProceduresFemaleHumansMaleRandomized Controlled Trials as TopicReperfusionStrokeThrombectomyThrombolytic Therapyhumansreperfusionstrokethrombectomythrombolytic therap
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