Abstract
PurposeMechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO.Materials and MethodsWe collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis.ResultsFifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients.ConclusionsMT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.
Highlights
Intravenous thrombolysis (IVT) has been proven to have a positive effect on patient survival and functional outcome in ischemic stroke if administered within a strict time window from symptom onset [1]
Purpose Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO)
The objective of this study was to evaluate the efficacy of MT without intravenous thrombolysis (IVT) in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO
Summary
Intravenous thrombolysis (IVT) has been proven to have a positive effect on patient survival and functional outcome in ischemic stroke if administered within a strict time window from symptom onset [1]. Mechanical thrombectomy (MT) performed with modern methods is vastly superior in treating this patient group [3]. Pienimaki et al.: In-Hospital Intravenous Thrombolysis Offers No Benefit. Favorable effect on clinical outcome [4,5,6,7]. Some studies have reported no significant effect on the outcome [8,9,10,11,12,13]. Found that there were more deaths at 3 months among the IVT-treated patients [14]
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