Abstract TP51: Comparison of Recanalization Rate Between Intravenous Actilyse and Intravenous Actilyse With Mechanical Thrombectomy in Larger Artery Occlusion Ischemic Stroke Patients

Abstract

Background and Purpose: According to the guidelines for acute ischemic stroke treatment, intravenous tissue plasminogen activator (IV-tPA) administration is the first line treatment and intraarterial thrombolysis (IA-Tx) with retrieval stent is regarded as additional treatment. But recanalization rate of large artery intracranial occlusion disease (LAICOD) after IV-tPA is very low and inconsistent according to the reports. Authors tried to find out the early recanalization rate of IV-tPA in patients with LAICOD. Methods: 278 with anterior circulation occlusion patients were included in this analysis. Brain CT-angiography (CTA) was an initial imaging study and acute stroke MRI was following after the IV-tPA. Recanalization rate was studied with initial CTA and followed MRA image. And other clinical outcomes were compared with IV-tPA, IA-Tx or perfusion/diffusion-mismatching (P/D-mismatching) or not. Results: The overall recanalization rate of LAICOD after IV-tPA was 15.5% (43/278), 86.0% (86/100) in patients treated with IA-Tx after IV-tPA, and 78.7% (48/61) in IA-Tx without IV-tPA. In patients who underwent IA-Tx after IV-tPA, P/D-mismatching patients showed higher recanalization rate (88.2% = 67/76 vs. 66.7% = 16/27, p = 0.020), and higher incidence of favorable outcomes (63.2% = 48/76 vs. 12.5% = 3/27, p = 0.000) compared to P/D-matching patients. Conclusion: This study suggests that recanalization rate after IV-tPA for the patients with acute ischemic stroke due to LAICOD is very low and IV-tPA before IA-Tx does not significantly influence on the neurologic outcomes and complication rates. Bridging treatment is effective, for stroke patient management, but authors would like to propose that IA-Tx might be applied as the first therapy option, just like in the management of acute myocardial infarction patients.