Letter by Tsivgoulis et al Regarding Article, “Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis”
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To the Editor:
We read with great interest the meta-analysis by Mistry et al1 evaluating the impact of pre-treatment with intravenous thrombolysis (IVT) on the outcomes of patients with acute ischemic stroke undergoing endovascular thrombectomy (ET) procedures. Even though current recommendations advocate that IVT pre-treatment should be offered to all eligible patients with large vessel occlusions before the initiation of endovascular reperfusion therapies, the comparative efficacy of direct ET versus bridging therapy (IVT+ET) in large vessel occlusions represents one of the most controversial topics of acute stroke care.
This meta-analysis1 included 13 cohorts (12 observational studies and 1 individual patient data meta-analysis of 5 randomized controlled clinical trials) and a total of 3553 patients with acute ischemic stroke treated with ET (62.5% with IVT pre-treatment). The investigators reported that bridging therapy was associated with higher rates of successful recanalization …