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Research ArticleNeurointervention

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

Seyed Behnam Jazayeri, Sherief Ghozy, Lina Hemmeda, Cem Bilgin, Mohamed Elfil, Ramanathan Kadirvel and David F. Kallmes
American Journal of Neuroradiology July 2024, DOI: https://doi.org/10.3174/ajnr.A8307
Seyed Behnam Jazayeri
aFrom the Sina Trauma and Surgery Research Center (S.B.J.), Tehran University of Medical Sciences, Tehran, Iran
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
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  • ORCID record for Seyed Behnam Jazayeri
Sherief Ghozy
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
cDepartment of Neurologic Surgery (S.G., R.K.), Mayo Clinic, Rochester, Minnesota
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  • ORCID record for Sherief Ghozy
Lina Hemmeda
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Cem Bilgin
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
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Mohamed Elfil
dDepartment of Neurological Sciences (M.E.), University of Nebraska Medical Center, Omaha, Nebraska
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Ramanathan Kadirvel
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
cDepartment of Neurologic Surgery (S.G., R.K.), Mayo Clinic, Rochester, Minnesota
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David F. Kallmes
bDepartment of Radiology (S.B.J., S.G., L.H., C.B., R.K., D.F.K.), Mayo Clinic, Rochester, Minnesota
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  • ORCID record for David F. Kallmes
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  • FIG 1.
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    FIG 1.

    PRISMA diagram detailing the literature search process.

  • FIG 2.
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    FIG 2.

    Meta-analysis with a random effects model shows a comparable risk of any ICH between MT and MT+IVT. ASTER indicates Contact Aspiration versus Stent Retriever for Successful Revascularization; RE, Random Effects; DEVT, A Randomized, Controlled, Multicenter Trial of Direct Endovascular Treatment versus Standard Bridging Therapy for Acute Stroke Patients with Large Vessel Occlusion in the Anterior Circulation; MR-CLEAN NO-IV, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands–NO IV.

  • FIG 3.
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    FIG 3.

    Meta-analysis with random effects shows a comparable risk of symptomatic ICH between MT and MT+IVT. DEVT indicates A Randomized, Controlled, Multicenter Trial of Direct Endovascular Treatment versus Standard Bridging Therapy for Acute Stroke Patients with Large Vessel Occlusion in the Anterior Circulation; ASTER, Contact Aspiration versus Stent Retriever for Successful Revascularization; MR-CLEAN NO-IV, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands–NO IV.

  • FIG 4.
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    FIG 4.

    Subgroup analysis of different symptomatic ICH definitions shows no difference between MT and MT+IVT. DEVT indicates A Randomized, Controlled, Multicenter Trial of Direct Endovascular Treatment versus Standard Bridging Therapy for Acute Stroke Patients with Large Vessel Occlusion in the Anterior Circulation; ASTER, Contact Aspiration versus Stent Retriever for Successful Revascularization; RE, Random Effect. MR-CLEAN NO-IV, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands–NO IV.

  • FIG 5.
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    FIG 5.

    Subgroup analysis of different symptomatic ICH anatomic descriptions shows no difference between MT and MT+IVT in the risk of hemorrhage at shown anatomic levels. MR-CLEAN NO-IV indicates Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands–NO IV; SWIFT-DIRECT, Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA versus DIRECT Solitaire Stent-Retriever Thrombectomy in Acute Anterior Circulation Stroke; DEVT, A Randomized, Controlled, Multicenter Trial of Direct Endovascular Treatment versus Standard Bridging Therapy for Acute Stroke Patients with Large Vessel Occlusion in the Anterior Circulation; ASTER, Contact Aspiration versus Stent Retriever for Successful Revascularization.

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Seyed Behnam Jazayeri, Sherief Ghozy, Lina Hemmeda, Cem Bilgin, Mohamed Elfil, Ramanathan Kadirvel, David F. Kallmes
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
American Journal of Neuroradiology Jul 2024, DOI: 10.3174/ajnr.A8307

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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
Seyed Behnam Jazayeri, Sherief Ghozy, Lina Hemmeda, Cem Bilgin, Mohamed Elfil, Ramanathan Kadirvel, David F. Kallmes
American Journal of Neuroradiology Jul 2024, DOI: 10.3174/ajnr.A8307
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