A Cochrane review included 5 studies with a total of 1 283 subjects. There was no significant difference in limb salvage or death at 30 days, six months or one year between initial surgery and initial thrombolysis (at 1 year for limb salvage OR 0.88 favours surgery, 95% CI 0.62 to 1.23, 2 studies, n=654; for death OR 0.87 favours thrombolysis, 95% CI 0.61 to 1.25, 3 studies, n=768). Stroke was significantly more frequent at 30 days in thrombolysis participants compared to surgery participants (1.3% vs. 0%; OR 6.41, 95% CI 1.57 to 26.22; 5 studies, n=1 180). Major haemorrhage was more likely at 30 days in thrombolysis participants compared to surgery participants (8.8% vs. 3.3%; OR 2.80, 95% CI 1.70 to 4.60; 4 studies, n=1 070); and distal embolization was more likely at 30 days in thrombolysis participants compared to surgery participants (12.4% vs. 0%; OR 8.35, 95% CI 4.47 to 15.58; 3 studies, n=678). Participants treated by initial thrombolysis underwent a less severe degree of intervention (OR 5.37, 95% CI 3.99 to 7.22; 3 studies, n=1046).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).