European Stroke Organisation – European Society for Minimally Invasive Neurological Therapy expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischaemic stroke and anterior circulation large vessel occlusion

作者：Guillaume Turc, Georgios K. Tsivgoulis, Heinrich J. Audebert, Hieronymus Damianus Boogaarts, Pervinder Bhogal, Gian Marco De Marchis, Ana Catarina Fonseca, Pooja Kumari Khatri, Mikaël Mazighi, Natàlia Pérez de la Ossa, Peter Dieter Schellinger, Daniel Strbian, Danilo Toni, Phil White, William N. Whiteley, Andrea Zini, Wim H. van Zwam, Jens Fiehler · 发表于：European Stroke Journal · 年份：2022 · DOI：10.1177/23969873221076968 · 被引用次数：112 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Venous Thromboembolism Diagnosis and Management

Six randomized controlled clinical trials have assessed whether mechanical thrombectomy (MT) alone is non-inferior to intravenous thrombolysis (IVT) plus MT within 4.5 hours of symptom onset in patients with anterior circulation large vessel occlusion (LVO) ischaemic stroke and no contraindication to IVT. An expedited recommendation process was initiated by the European Stroke Organisation (ESO) and conducted with the European Society of Minimally Invasive Neurological Therapy (ESMINT) according to ESO standard operating procedure based on the GRADE system. We identified two relevant Population, Intervention, Comparator, Outcome (PICO) questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if insufficient evidence was available to provide recommendations based on the GRADE approach. For stroke patients with anterior circulation LVO directly admitted to a MT-capable centre ('mothership') within 4.5 hours of symptom onset and eligible for both treatments, we recommend IVT plus MT over MT alone (moderate evidence, strong recommendation). MT should not prevent the initiation of IVT, nor should IVT delay MT. In stroke patients with anterior circulation LVO admitted to a centre without MT facilities and eligible for IVT ≤4.5 hrs and MT, we recommend IVT followed by rapid transfer to a MT capable-centre ('drip-and-ship') in preference to omitting...