Abstract Details

Title Comparative Outcomes of IVT+EVT Versus EVT Alone in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-010

Objective To systematically evaluate the comparative efficacy and safety of combined intravenous thrombolysis plus endovascular thrombectomy (IVT+EVT) versus endovascular thrombectomy alone (EVT) in patients with acute ischemic stroke due to large vessel occlusion.

Background Acute ischemic stroke with large vessel occlusion remains a leading cause of mortality and disability worldwide. While endovascular thrombectomy is standard of care, whether bridging intravenous thrombolysis provides additional benefit remains controversial, necessitating comprehensive meta-analysis.

Design/Methods We performed systematic review and meta-analysis of six randomized controlled trials comparing IVT+EVT versus EVT alone: DIRECT-MT (2020), SKIP (2021), DEVT (2021), MR CLEAN NO-IV (2021), SWIFT DIRECT (2022), and RESCUE-JAPAN LIMIT (2023), encompassing 2,244 patients with anterior circulation large vessel occlusion (IVT+EVT: n=1,122; EVT alone: n=1,122). Primary outcome was functional independence at 90 days (modified Rankin Scale 0-2). Secondary outcome was excellent functional outcome (mRS 0-1). Risk ratios with 95% confidence intervals were calculated using fixed-effects meta-analysis.

Results

Primary outcome demonstrated 623 events in IVT+EVT group versus 652 events in EVT alone group. Pooled risk ratio was 1.01 (95% CI: 0.95-1.08, p=0.72), indicating no significant difference. Between-study heterogeneity was minimal (I²=12%, τ²=0.001, p=0.34). For secondary outcome, risk ratio was 1.04 (95% CI: 0.94-1.16, p=0.44) with low heterogeneity (I²=8%, τ²=0.002, p=0.37). Individual trial risk ratios ranged from 0.93 to 1.37, with all confidence intervals crossing unity.

Conclusions Endovascular thrombectomy alone demonstrates non-inferiority to combined IVT+EVT for acute ischemic stroke with large vessel occlusion. Direct EVT achieved equivalent functional independence at 90 days across international trials. These findings support direct EVT as an evidence-based alternative to bridging therapy, particularly when intravenous thrombolysis may cause treatment delays or is contraindicated. Treatment selection should be individualized based on patient characteristics, symptom onset time, and institutional capabilities.

Authors/Disclosures
Aditi Agarwal PRESENTER	Aditi Agarwal has nothing to disclose.
Binay Panjiyar, MBBS	Dr. Panjiyar has nothing to disclose.
Govind S. Mann, MBBS	Dr. Mann has nothing to disclose.
SAI VENKATA MANOJ KOTHARU, MBBS	Dr. KOTHARU has nothing to disclose.
Simranjeet S. Nagoke, MBBS	Dr. Nagoke has nothing to disclose.

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