Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion

Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T. Froehler, J. Mocco, Abhi Pandhi, Ramin Zand, Konark Malhotra, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D. Turner, Justin R Mascitelli, Kiersten Espaillat, Aristeidis H. Katsanos, Anne W. Alexandrov, Andrei V. Alexandrov, Adam S. Arthur

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. Methods Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. Results A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95% CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26-0.96). Conclusions This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. Classification of evidence This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.

Original languageEnglish (US)
Pages (from-to)e1274-e1282
JournalNeurology
Volume90
Issue number15
DOIs
StatePublished - Apr 10 2018
Externally publishedYes

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Thrombectomy
Safety
Mechanical Thrombolysis
Propensity Score
Confidence Intervals
Group Psychotherapy
Odds Ratio
Cerebral Infarction
Multicenter Studies
Reperfusion
Observational Studies
Research Design
Randomized Controlled Trials
Stroke

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Goyal, N., Tsivgoulis, G., Frei, D., Turk, A., Baxter, B., Froehler, M. T., ... Arthur, A. S. (2018). Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion. Neurology, 90(15), e1274-e1282. https://doi.org/10.1212/WNL.0000000000005299

Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion. / Goyal, Nitin; Tsivgoulis, Georgios; Frei, Donald; Turk, Aquilla; Baxter, Blaise; Froehler, Michael T.; Mocco, J.; Pandhi, Abhi; Zand, Ramin; Malhotra, Konark; Hoit, Daniel; Elijovich, Lucas; Loy, David; Turner, Raymond D.; Mascitelli, Justin R; Espaillat, Kiersten; Katsanos, Aristeidis H.; Alexandrov, Anne W.; Alexandrov, Andrei V.; Arthur, Adam S.

In: Neurology, Vol. 90, No. 15, 10.04.2018, p. e1274-e1282.

Research output: Contribution to journalArticle

Goyal, N, Tsivgoulis, G, Frei, D, Turk, A, Baxter, B, Froehler, MT, Mocco, J, Pandhi, A, Zand, R, Malhotra, K, Hoit, D, Elijovich, L, Loy, D, Turner, RD, Mascitelli, JR, Espaillat, K, Katsanos, AH, Alexandrov, AW, Alexandrov, AV & Arthur, AS 2018, 'Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion', Neurology, vol. 90, no. 15, pp. e1274-e1282. https://doi.org/10.1212/WNL.0000000000005299
Goyal N, Tsivgoulis G, Frei D, Turk A, Baxter B, Froehler MT et al. Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion. Neurology. 2018 Apr 10;90(15):e1274-e1282. https://doi.org/10.1212/WNL.0000000000005299
Goyal, Nitin ; Tsivgoulis, Georgios ; Frei, Donald ; Turk, Aquilla ; Baxter, Blaise ; Froehler, Michael T. ; Mocco, J. ; Pandhi, Abhi ; Zand, Ramin ; Malhotra, Konark ; Hoit, Daniel ; Elijovich, Lucas ; Loy, David ; Turner, Raymond D. ; Mascitelli, Justin R ; Espaillat, Kiersten ; Katsanos, Aristeidis H. ; Alexandrov, Anne W. ; Alexandrov, Andrei V. ; Arthur, Adam S. / Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion. In: Neurology. 2018 ; Vol. 90, No. 15. pp. e1274-e1282.
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abstract = "Objective In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. Methods Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. Results A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95{\%} confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95{\%} CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95{\%} CI 0.26-0.96). Conclusions This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. Classification of evidence This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.",
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T1 - Comparative safety and efficacy of combined ivt and mt with direct mt in large vessel occlusion

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Frei, Donald

AU - Turk, Aquilla

AU - Baxter, Blaise

AU - Froehler, Michael T.

AU - Mocco, J.

AU - Pandhi, Abhi

AU - Zand, Ramin

AU - Malhotra, Konark

AU - Hoit, Daniel

AU - Elijovich, Lucas

AU - Loy, David

AU - Turner, Raymond D.

AU - Mascitelli, Justin R

AU - Espaillat, Kiersten

AU - Katsanos, Aristeidis H.

AU - Alexandrov, Anne W.

AU - Alexandrov, Andrei V.

AU - Arthur, Adam S.

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N2 - Objective In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. Methods Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. Results A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95% CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26-0.96). Conclusions This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. Classification of evidence This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.

AB - Objective In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. Methods Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. Results A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95% CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26-0.96). Conclusions This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. Classification of evidence This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.

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