ISC 2023 | IRIS Collaboration pooled analysis: EVT alone versus with prior thrombolysis

Manon Kappelhof, MD, PhD, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands, and Johannes Kaesmacher, MD, PhD, Inselspital, Bern University Hospital, Bern, Switzerland, share the results of the IRIS collaboration individual participant data meta-analysis of six randomized, controlled trials assessing the use of endovascular treatment (EVT) alone versus EVT with prior intravenous thrombolysis (IVT). The trials had mixed outcomes, with the majority reporting inconclusive findings. As part of the ongoing effort to define the value of IVT bridging therapy, study authors pooled the data from over 2000 patients, asking if direct EVT was non-inferior to EVT with IVT, using an established non-inferiority boundary of 5% absolute difference in functional independence. Overall, there was no significant difference in 90-day mRS between the two arms, but non-inferiority of EVT alone could not be shown (49% mRS 0-2 after EVT alone versus 51% after IVT+EVT). Patients in the IVT+EVT arm had higher rates of successful reperfusion, but also higher rates if any intracranial hemorrhage. Dr Kaesmacher comments on how to interpret these data for application to daily practice. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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