Comparison the therapeutic effect of intra-arterial thrombolysis and intravenous thrombolysis for acute ischemic cerebral infarction within 6 hours of onset: A meta-analysis
10.3969/j.issn.1672-5921.2011.03.001
- Author:
Yu-Kai LIU
1
Author Information
1. Department of Neurology
- Publication Type:Journal Article
- Keywords:
Acute disease;
Brain infarction;
Infusions, intra-arterial;
Infusions, intravenous;
Meta-analysis;
Thrombolytic therapy
- From:
Chinese Journal of Cerebrovascular Diseases
2011;8(3):113-118
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To evaluate the efficacy and safety of intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction through a meta-analysis. Methods: The literatures of the randomized controlled trials of using urokinase or recombinant tissue plasminogen activator for intra-arterial thrombolysis and intravenous thrombolysis in the treatment of acute ischemic cerebral infarction from January 1 ,2000 to August 5,2010 were reviewed. The primary outcome measures were the proportions of neurological improvement (basic cure + excellent results) in the intra-arterial thrombolysis and intravenous thrombolysis groups. The secondary outcome measures were the European Stroke Scale (ESS) scores after the treatment and the proportion of symptomatic intracranial hemorrhage. The meta-analysis software, RevMan 4. 2 was applied for pooling the data of all the findings. Two reviewers extracted the data independently. Results: A total of 11 articles either from foreign or domestic sources and 723 patients with acute cerebral infarction were included, in which 305 patients underwent intra-arterial thrombolysis and 418 underwent intravenous thrombolysis. Circled digit oneThe total improvement rate of the intra-arterial thrombolysis was 70. 92% and that of intravenous thrombolysis was 61. 29%. There was significant difference between them (χ2 =4. 895,P < 0. 05). Amelioration of neurological function deficits in the intra-arterial thrombolysis group was significantly higher than that in the intravenous thrombolysis group ( OR = 1. 79, 95% CI 1. 19 -2.70, P=0. 005). ESS score within 24 hours after the thrombolysis was significantly higher in the intra-arterial thrombolysis group than that in the intravenous thrombolysis group ( WMD =7. 69, 95%CI;4. 80 - 10. 59,P <0.000 01 ). Circled digit twoThe rate of symptomatic intracranial hemorrhage in the intra-arterial thrombolysis group was 7.54% and in the intravenous thrombolysis group was 6.94%. There was no significant difference between the two groups (χ2 = 0. 096, P > 0. 7 ). There was no significant difference in thrombolytic modes in the risk of complicating intracranial hemorrhage between the two groups (OR = 1. 12, 95% CI:0. 63 - 2.01,P = 0.69). Conclusion: The efficacy of intra-arterial thrombolysis for acute cerebral infarction is superior to that of intravenous thrombolysis, and both the incidences of symptomatic intracranial hemorrhage is comparable. A large, high-quality randomized controlled trial is need for further verification.
