title: Intravenous versus intra-arterial thrombolysis in ischemic stroke: a systematic review and meta-analysis.
abstract: BACKGROUND
  Reperfusion following ischemic stroke can be attained by either intravenous thrombolysis (IVT) or intra-arterial thrombolysis (IAT). Only a limited number of randomized prospective studies have compared the efficacy and safety of IVT and IAT. This meta-analysis investigated possible clinical benefits of IAT relative to IVT in patients with acute ischemic stroke.
  
  
  METHODS
  We searched the PubMed, Cochrane, and Google Scholar databases through October 2013 for manuscripts that describe the findings of randomized controlled or prospective studies that evaluated the outcomes of patients with ischemic stroke who were treated with IVT or IAT. The clinical outcome measures were score on the modified Rankin scale (mRS) and mortality at 90 days. A favorable outcome was defined as an mRS score of 0 to 2.
  
  
  RESULTS
  For the mRS, the combined odds ratio (OR) of 3.28 (95% confidence interval (CI), 1.91 to 5.65, P < 0.001) indicated that patients who received IAT had a significantly higher chance for a favorable outcome than did those who received IVT. For mortality, the OR indicated that IAT therapy significantly reduced the proportion of patients who died within 90 days of the procedure (combined OR, 0.40; 95%CI, 0.17 to 0.92; P = 0.032).
  
  
  CONCLUSIONS
  This meta-analysis determined that IAT conferred a significantly greater probability of achieving a favorable outcome compared with IVT. There was also a significant difference in mortality rates between IAT and IVT. The studies included in this analysis were small and heterogeneous; therefore, larger randomized prospective clinical studies are necessary to further investigate this issue.
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Qing-feng
authors.initials: QF
authors.lastname: Ma
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Chang-biao
authors.initials: CB
authors.lastname: Chu
authors.affiliation: Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
authors.forename: Hai-qing
authors.initials: HQ
authors.lastname: Song
mesh_terms: D016208:Databases, Factual; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D016017:Odds Ratio; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents