TY - JOUR
T1 - Comparison of combined intravenous and intraarterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy
T2 - a propensity-matched analysis
AU - Elawady, Sameh Samir
AU - Kasem, Rahim Abo
AU - Mulpur, Bhageeradh
AU - Cunningham, Conor
AU - Matsukawa, Hidetoshi
AU - Sowlat, Mohammad Mahdi
AU - Orscelik, Atakan
AU - Nawabi, Noah L.A.
AU - Isidor, Julio
AU - Maier, Ilko
AU - Jabbour, Pascal
AU - Kim, Joon Tae
AU - Wolfe, Stacey Q.
AU - Rai, Ansaar
AU - Starke, Robert M.
AU - Psychogios, Marios Nikos
AU - Samaniego, Edgar A.
AU - Yoshimura, Shinichi
AU - Cuellar, Hugo
AU - Howard, Brian M.
AU - Alawieh, Ali
AU - Alaraj, Ali
AU - Ezzeldin, Mohamad
AU - Romano, Daniele G.
AU - Tanweer, Omar
AU - Mascitelli, Justin R.
AU - Fragata, Isabel
AU - Polifka, Adam J.
AU - Siddiqui, Fazeel
AU - Osbun, Joshua W.
AU - Grandhi, Ramesh
AU - Crosa, Roberto Javier
AU - Matouk, Charles
AU - Park, Min S.
AU - Brinjikji, Waleed
AU - Moss, Mark
AU - Daglioglu, Ergun
AU - Williamson, Richard
AU - Navia, Pedro
AU - Kan, Peter
AU - De Leacy, Reade Andrew
AU - Chowdhry, Shakeel A.
AU - Altschul, David
AU - Spiotta, Alejandro M.
AU - Levitt, Michael R.
AU - Goyal, Nitin
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
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U2 - 10.1136/jnis-2024-021975
DO - 10.1136/jnis-2024-021975
M3 - Article
C2 - 39179373
AN - SCOPUS:85204793527
SN - 1759-8478
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
ER -