Evidence map›Paper›PMID 36581469›Full record

SynthesisNeurology2023

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy: A Systematic Review and Meta-analysis.

Aristeidis H Katsanos, Amrou Sarraj, Michael Froehler, Jan Purrucker, Nitin Goyal, Robert William Regenhardt, Lina Palaiodimou, Nils H Mueller-Kronast, Robin Lemmens, Peter D Schellinger and 4 more

Open access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurology, 2023. 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.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 2 pooled it
3.4field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Article
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  6. Article
  7. Article
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  11. Review
  12. Drip and ship in patients with acute ischemic stroke: a narrative review.Therapeutic advances in neurological disorders · 2025
    Review
  13. Article
  14. Article
  15. Review
  16. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 1 institution in 2 countries.

Aristeidis H KatsanosFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Amrou SarrajFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.ORCID 0000-0001-5726-4478
Michael FroehlerFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Jan PurruckerFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Nitin GoyalFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Robert William RegenhardtFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.ORCID 0000-0003-2958-3484
Lina PalaiodimouFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Nils H Mueller-KronastFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Robin LemmensFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.ORCID 0000-0002-4948-5956
Peter D SchellingerFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Simona SaccoFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.ORCID 0000-0003-0651-1939
Guillaume TurcFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.ORCID 0000-0001-5059-4095
Andrei V AlexandrovFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France.
Georgios TsivgoulisFrom the Division of Neurology (A.H.K.), McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada; Department of Neurology (A.S.), Case Western Reserve University, University Hospitals Cleveland Medical Center, OH; Cerebrovascular Program (M.F.), Vanderbilt University Medical Center, Nashville, TN; Department of Neurology (J.P.), Heidelberg University Hospital, Germany; Department of Neurology (N.G., A.V.A., G. Tsivgoulis), University of Tennessee Health Science Center, Memphis; Departments of Neurosurgery and Neurology (R.W.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Second Department of Neurology (L.P., G. Tsivgoulis), Attikon University Hospital, National and Kapodistrian University of Athens, Greece; Advanced Neuroscience Network/Tenet South Florida (N.H.M.), Delray Beach; Department of Neurosciences (R.L.), Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven; Center for Brain & Disease Research (R.L.), Laboratory of Neurobiology, VIB; Department of Neurology (R.L.), University Hospitals Leuven, Belgium; Departments of Neurology and Neurogeriatrics (P.D.S.), Johannes Wesling Medical Center Minden, University Hospitals of the Ruhr-University of Bochum, Germany; Department of Biotechnological and Applied Clinical Sciences (S.S.), University of L'Aquila, Italy; Department of Neurology (G. Turc), GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, INSERM U1266, FHU NeuroVasc, France. tsivgoulisgiorg@yahoo.gr.
University of Tennessee Health Science Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesThe role of IV thrombolysis (IVT) in patients with large vessel occlusions (LVOs) administered before transfer from a primary stroke center (PSC) to a comprehensive stroke center (CSC) is questioned.

methodsWe included observational studies of patients with an LVO receiving IVT at a PSC before their endovascular thrombectomy (EVT) transfer compared with those receiving EVT alone. Efficacy outcomes included excellent or good functional outcomes (modified Rankin Scale [mRS] scores of 0-1 or 0-2, respectively) and reduced disability (mRS shift analysis) at 3 months. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 hours and 3-month all-cause mortality. Associations are reported with crude odds ratios (ORs) and adjusted ORs (aORs).

resultsWe identified 6 studies, including 1,723 participants (mean age: 71 years, 51% women; 53% treated with IVT at a PSC). The mean onset-to-groin puncture time did not differ between the 2 groups (mean difference: -20 minutes, 95% CI -115.89 to 76.04). Patients receiving IVT before transfer had higher odds of 3-month reduced disability (common OR = 1.98, 95% CI 1.17-3.35), excellent (OR = 1.70, 95% CI 1.28-2.26), and good (OR = 1.62.95% CI 1.15-2.29) functional outcomes, with no increased sICH (OR = 0.87, 95% CI 0.54-1.39) or mortality (OR = 0.55, 95% CI 0.37-0.83) risks. In the adjusted analyses, patients receiving IVT at a PSC had higher odds of excellent functional outcome (aOR = 1.32, 95% CI 1.00-1.74) and a lower probability for mortality (aOR = 0.50, 95% CI 0.27-0.93). DISCUSSION: Patients with LVO receiving IVT at a PSC before an EVT transfer have a higher likelihood of excellent functional recovery and lower odds of mortality, with no increase in sICH and onset-to-groin puncture times, compared with those transferred for EVT without previously receiving IVT.

Indexed as

Brain IschemiaEndovascular ProceduresStrokeAgedFemaleFibrinolytic AgentsHumansIntracranial HemorrhagesMaleThrombectomyThrombolytic TherapyTreatment OutcomeFibrinolytic Agents

Identifiers

PMID36581469
PMCPMC10104605
OpenAlexW4313312213

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