The Clinical Effectiveness of Intra-Arterial versus Intravenous Thrombolysis on the Treatment of Patients with Acute Stroke: A Systematic Review and Meta-Analysis in Clinical Evidence

Context: Application of anti-clot drugs such as recombinant tissue plasminogen activator (rt-PA) to treat patients with strokes is considered as a standard treatment employed through two techniques: intra-arterial and intravenous thrombolysis. The current study aimed at comparing the clinical effectiveness of these two injection techniques. Methods: The current systematic review searched Google Scholar, Web of Science, Embase, Cochrane, and PubMed databases. The time span of the searching was from 1990 to 2017. The quality of the selected articles was evaluated. The fixed effects and random effects models were used in the meta-analysis. The results were subject to sensitivity analysis in the specified interval. CMA.2 (Comprehensive Meta-Analysis 2) software was utilized to conduct the meta-analysis; α value was considered 5%. Results: Eight studies met the inclusion/exclusion criteria. Intra-arterial thrombolysis was more effective to reduce mortality rate (odds ratio (OR) = 0.40; 95% confidence interval (CI): 0.17 - 0.92; P = 0.032). Intra-arterial thrombolysis was more effective to improve symptoms compared with intravenous thrombolysis (OR = 3.28; CI: 1.91 - 5.65; P < 0.001). Neurological dementia was bigger in the intra-arterial thrombolysis group compared with that of intravenous thrombolysis group. The mean of recanalization was 49% and 50.8% in the intra-arterial and intravenous thrombolysis groups, respectively; the difference between the results was not statistically significant (P > 0.05). Intracranial hemorrhage value was 11.33 % and 9.52 % in the intra-arterial and intravenous thrombolysis groups, respectively, which was not statistically significant (P > 0.05). Conclusions: In spite of the low number of robust evidence, it can be concluded that intra-arterial thrombolysis can be more effective than intravenous thrombolysis.