Abstract
Objective and design
Whether combining intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is superior to mechanical thrombectomy alone for large vessel occlusion acute ischemic stroke is still uncertain. Our aim was to compare the safety and the efficacy of these two therapeutic strategies.
Materials
Patients with acute ischemic stroke secondary to anterior circulation large vessel occlusion.
Methods
A retrospective analysis was conducted. IVT was performed with full dose recombinant tissue plasminogen activator. MT alone was performed only if intravenous thrombolysis was contraindicated. Primary outcomes were successful reperfusion, 3-month functional independence, symptomatic intracranial hemorrhage (sICH), and 3-month mortality.
Results
325 patients were analyzed: 193 treated with combined IVT and MT, 132 with MT alone. The combined treatment group showed higher systolic blood pressure (140 [80–230] vs 150 [90–220]; p = 0.036), rate of good collaterals (55.9% vs 67%; p = 0.03), use of aspiration devices (68.2% vs 79.3%; p = 0.003) and shorter onset-to-reperfusion time (300 [90–845] vs 288 [141–435]; p = 0.008). No differences were found in the efficacy and safety outcomes except for mortality which was lower in the combined treatment group (36.4% vs 25.4%; p = 0.02). However, after multivariable analysis combined treatment was not associated with lower mortality (OR 1.47; 95% CI 0.73–2.96; p = 0.3).
Conclusions
Our study suggests that mechanical thrombectomy alone is effective and safe in patients with contraindications to intravenous thrombolysis. Preceding use of IVT in eligible patients was not associated with increased harm or benefit. Randomized controlled trials are needed to clarify whether intravenous thrombolysis before mechanical thrombectomy is associated with additional benefit.
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Acknowledgements
This work was supported by the Italian Ministry of Health (RF-2013-02358679). We are grateful to Caterina Motta MD, Francesco Mori MD, Simone Napolitano, Domenico Samà MD, Barbara Rizzato MD, Vittoria Carla D’Agostino MD, Angela Giordano MD, Marta Panella MD, Alessandro Davoli MD for collection of data.
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None in study design, collection, analysis and interpretation of data, writing and decision to submit the article for publication.
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Sallustio, F., Koch, G., Alemseged, F. et al. Effect of mechanical thrombectomy alone or in combination with intravenous thrombolysis for acute ischemic stroke. J Neurol 265, 2875–2880 (2018). https://doi.org/10.1007/s00415-018-9073-7
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DOI: https://doi.org/10.1007/s00415-018-9073-7