Meta-analysis:The Clinic Benefit And Safety Of Arteriovenous Thrombolysis In Treatment Of Acute Cerebral Infarction

Background:Thrombolytic therapy has become the important means to help restore the apoplexy reperfusion of acute ischemic stroke, however,at present thrombolysis methods mainly with intravenous thrombolysis and artery thrombolysis, only a few random prospectie case-control study of arteriovenous thrombolysis.Objective: The purpose of this article is to evaluate the benefit and safety of arteriovenous thrombolysis in treatment of acute cerebral infarction.Methods: With English phrases about intravenous thrombolysis,intra-arterial thrombolysis,IA,IV,IA+IV, acute cerebral infarction,acute ischemic stroke, combined,randomized controlled trials to search the Cochrane Library、Pub Med、CNKI、VIP Database、Wanfang Database by computer to collect randomized controlled trials of arteriovenous thrombolysis in treatment of acute cerebral infarction in 1999-2016.According to inclusion and exclusion criteria,extracting information and assess the quality, and then conduct Meta analysis by using Rev Man 5. 3.Result: including the 9 literatures in Chinese and English, total of 516 cases, combined intravenous and intra-arterial thrombolysis are 240 cases,intravenous thrombolysis alone or intra-arterial thrombolysis alone are276 cases.(1)The total effective rate of arteriovenous thrombolysis is higher than intravenous or intra-arterial thrombolysis alone: improve of 24 h NIHSS(reduce > 4) for combined group’s is better than alone group(OR=2.34,95%CI 1.57-3.48,P<0.01)and three month m Rs score(0-2)is also better than alone group(OR=1.79,95%CI 1.14-2.82,P=0.01);(2)the recanalization rate of combined group is higher than alone group( OR=2.35,95%CI 1.52-3.62, P < 0.01);(3) Safety of combined intravenous and intra-arterial thrombolysis has no obvious difference with intravenous or intra-arterial thrombolysis alone: 2 groups’ symptomatic hemorrhage(OR=0.59,95% 0.33-1.07,P=0.08);Motality rate of 2 groups is similar(OR=0.84,95% 0.43-1.65,P=0.61).Conclusion: The efficacy and safety of combined intravenous and intra-arterial thrombolysis for acute cerebral infarction is superior to that of intravenous or intra-arterial thrombolysis alone.