Intravenous thrombolysis combined with endovascular treatment improves 90-day functional independence in tandem lesion strokeCombined Treatments Show Better Outcomes for Specific Stroke Patients

OBJECTIVE: For patients suffering from acute ischemic stroke (AIS) brought on by tandem lesions (TL), to compare the safety and efficacy of intravenous thrombolysis (IVT) in conjunction with endovascular therapy (EVT) to EVT alone. METHODS: Relevant studies published up until October 20, 2024, were found by a systematic assessment of the literature from the PubMed, Embase, and Cochrane databases. Results such as the 90-day modified Rankin Scale (mRS) score, effective recanalization, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality were the main focus of the comparison between IVT plus EVT and EVT alone in patients with TL. RESULTS: A total of 1756 patients from nine studies were included in the final analysis; 976 of these patients were categorized as IVT + EVT group patients, and 780 as EVT alone group patients. The IVT plus EVT group was associated with a higher rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score [mTICI] ≥ 2b/3) (RR = 1.11; 95% CI, 1.04-1.18; p < 0.05; I = 27%) and improved functional independence at 90 days (mRS 0-2) (RR = 1.27; 95% CI, 1.13-1.42; p < 0.05; I = 0%). There was no discernible difference in the two groups' risk of sICH (RR = 0.72; 95% CI, 0.46-1.12; p > 0.05; I = 20%). Furthermore, the 90-day mortality rate was lower for IVT with EVT than for EVT alone (RR = 0.67; 95% CI, 0.52-0.87; p < 0.05; I = 0%). CONCLUSION: IVT + EVT, as opposed to EVT alone, may be correlated with superior functional results at 90 days in AIS patients with TL.