IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

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).DiscussionPatients 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.