Comparative Efficacy and Safety of Thrombectomy Versus Thrombolysis for Large Vessel Occlusion in Acute Ischemic Stroke: A Systemic Review

Abstract

Acute ischemic stroke (AIS) is a common cause behind a significant number of people who develop disabilities or die worldwide. Most of the strokes that occur globally are attributed to AIS as a result of large vessel occlusions that typically occur in arteries like the internal carotid and middle cerebral arteries. Primary treatments for AIS are mechanical thrombectomy (MT) and intravenous thrombolysis (IVT), and the clinical scenario can dictate what method would provide the most optimal outcome for the patient. MT has a more favorable efficacy and safety profile but can be more technically challenging and time-consuming. This article conducts a comparison with regard to safety and efficacy between MT and IVT, which are the primary treatment methods for AIS. The PubMed, Cochrane Library, Europe PubMed Central, Science Direct, and Google Scholar databases were used to search for relevant articles. This search was conducted from June 2024 to July 2024. The process involved examining the titles and abstracts of all relevant publications after which, the selected articles were read entirely to confirm eligibility. The Risk of Bias in Nonrandomized Studies of Interventions I tool was used to assess for bias in the articles selected. The management of AIS involving IVT with or without MT is highly dependent on the clinical scenario. Nevertheless, MT alone has demonstrated better or comparable functional outcomes in patients compared to both bridging therapy (BT) and IVT alone. However, it is important to note that in select patient groups, such as those with large artery atherosclerosis, BT has been able to show better efficacy than MT alone. Given the significant burden of AIS on patient quality of life and healthcare spending, it is prudent to continue to explore newer thrombolytics and thrombectomy techniques