OBJECTIVES : To evaluate the clinical efficacy and safety of mechanical thrombectomy (MTE) in patients with acute ischemic stroke (AIS).

METHODS : The search of systematic reviews and meta-analyses was conducted in PubMed and the Cochrane Library databases in April 2019. Selection criteria included studies published in English that reported comparative efficacy of MTE added to thrombolytic therapy (MTE+TLT) or MTE alone vs TLT or MTE alone in patients with AIS.

RESULTS : Twenty publications were included. Thirteen meta-analyses showed that MTE+TLT vs TLT alone statistically significantly improves functional outcomes: more patients achieve independency (modified Rankin Scale (mRS) score 0–2 at 90 days), excellent functional outcome (mRS 0–1 at 90 days), - as well as early neurological improvement and recanalisation rate. Three meta-analyses found that MTE + TLT statistically significantly did not differ from MTE alone. Two meta-analyses showed that MTE + TLT vs MTE alone statistically significantly improves functional outcomes and recanalisation rate. Only one meta-analysis revealed increased mortality among patients who received TLT alone. There was no statistically significant differences in mortality between MTE + TLT, MTE alone or TLT alone in all other meta-analysis. In terms of hemorrhage, no differences were found among these treatment strategies except for two meta-analyses showing a greater incidence of intracranial and intracerebral hemorrhages for TLT.

CONCLUSIONS : MTE + TLT has better efficacy and safety compared with TLT or MTE alone and better safety compared with TLT alone in patients with AIS.