Date of Award

8-1-2021

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Eric Van Hecke

Abstract

Background: Discussion whether intravenous tPA or mechanical thrombectomy is the ideal choice for treatment of acute ischemic strokes has been debated around the medical community for last three decades. However still, after several clinical trials, it is still unclear if one is superior to the other.

Methods: This meta-analysis pooled several different results from studies revolving around treatment of acute ischemic stroke. The goal of this paper was to evaluate whether previous clinical trials favoring mechanical thrombectomy had sufficient research to prove it is superior to treatment with tPA in reducing long-term morbidity. Primary outcomes measured were the modified Rankin scales at 90 days in evaluation of long-term morbidity.

Results: Sixteen different studies were evaluated, six trials evaluating tPA efficacy and ten trials evaluating mechanical thrombectomy efficacy. Only two out of 6 tPA studies showed positive benefit, and seven out of ten mechanical thrombectomy studies showed positive benefit.

Conclusion: It is difficult to determine if mechanical thrombectomy is superior to tPA management due to several confounders and possible study bias in majority of studies showing positive results in mechanical thrombectomy patients. For example, the majority of positive mechanical thrombectomy studies and the most common confounder were the studies being stopped early. which are then susceptible to bias. More studies will need to be conducted, and fully completed, in order to determine if there is positive benefit over tPA.

Identifier

SC 11.PAS.2021.Barry.C

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