Comparison of combined intravenous and intraarterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis

Sameh Samir Elawady, Rahim Abo Kasem, Bhageeradh Mulpur, Conor Cunningham, Hidetoshi Matsukawa, Mohammad Mahdi Sowlat, Atakan Orscelik, Noah L.A. Nawabi, Julio Isidor, Ilko Maier, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. Samaniego, Shinichi Yoshimura, Hugo Cuellar, Brian M. HowardAli Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G. Romano, Omar Tanweer, Justin R. Mascitelli, Isabel Fragata, Adam J. Polifka, Fazeel Siddiqui, Joshua W. Osbun, Ramesh Grandhi, Roberto Javier Crosa, Charles Matouk, Min S. Park, Waleed Brinjikji, Mark Moss, Ergun Daglioglu, Richard Williamson, Pedro Navia, Peter Kan, Reade Andrew De Leacy, Shakeel A. Chowdhry, David Altschul, Alejandro M. Spiotta, Michael R. Levitt, Nitin Goyal

Producción científica: Articlerevisión exhaustiva

Resumen

Background A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT. Methods STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0–2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality. Results A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51–1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0–1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0–1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04). Conclusion The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.

Idioma originalEnglish (US)
PublicaciónJournal of neurointerventional surgery
DOI
EstadoAccepted/In press - 2024

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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