Abstract
BackgroundIntravenous thrombolysis therapy (IVT) bridged with intra-arterial thrombectomy (IAT) has recently been recommended as favorable treatment option to ensure that the thrombolytic effect is delivered to the affected region for acute ischemic stroke patients. However, there remains a lack of studies reporting outcome prediction in this group of patients. In this study, we aimed to identify indicators from baseline data that could be used for early prediction of long-term functional outcomes.MethodsThis retrospective single center cohort study included acute ischemic stroke (AIS) patients (n = 92) who received IVT and IAT. Functional outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index. We investigated the relationship between functional outcomes at one-year post-procedure and potential predictors such as occlusion site, modified thrombolysis in cerebral infarction (mTICI) score following the IVT/IAT procedure, and degree of stenosis measured by carotid duplex.Results67.4% of the studied patients had satisfactory outcomes with mTICI grades of 2b or 3. From baseline to one-year post-procedure, the NIHSS score improved in 88.0%, the mRS score improved in 69.6%, and the Barthel index improved with 59.8%. Patients with internal carotid artery (ICA) or vertebral artery (VA) stenosis detected by carotid duplex had significantly poorer functional outcomes, measured by the mRS score and Barthel index. In patients with a satisfactory mTICI grade, improvement in the mRS score was only observed in 60.0% of patients with ICA stenosis, compared to 93.8% without ICA stenosis. The VA stenosis was the most significant factor associated with the improvement of mRS (OR = 0.08; 95% CI: 0.01–0.63; P = 0.017) and Barthel Index (OR = 0.06; 95% CI: 0.01–0.47; P = 0.008) in multiple regression analysis.ConclusionsICA or VA stenosis detected by carotid duplex could serve as predictors of significantly poorer functional outcomes in stroke patients treated with bridging therapy; they might be useful clinical markers, particularly as stenosis could be detected by a non-invasive and portable method.
Highlights
Intravenous thrombolysis therapy (IVT) bridged with intra-arterial thrombectomy (IAT) has recently been recommended as favorable treatment option to ensure that the thrombolytic effect is delivered to the affected region for acute ischemic stroke patients
The current American Heart and Stroke Associations’ (AHA/ASA) guidelines recommend with level of evidence A that “patients should receive mechanical thrombectomy with a stent retriever if they meet all the following criteria: (1) pre-stroke modified Rankin Scale score of 0 to 1; (2) causative occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA) segment 1 (M1); (3) age ≥ 18 years; (4) National Institute of Health Stroke Scale (NIHSS) score ≥ 6; (5) Alberta Stroke Program Early computed tomographic (CT) Score (ASPECTS) ≥ 6; and (6) treatment can be initiated within 6 hours of symptom onset.”
Patient involvement In this retrospective study, data were collected from the medical records of 92 consecutive acute ischemic stroke (AIS) patients who underwent IVT bridged with IAT therapy during the period January 2015 to April 2017 at the angiography laboratory of the Department of Neuroimaging, Changhua Christian Hospital, Changhua, Taiwan
Summary
Intravenous thrombolysis therapy (IVT) bridged with intra-arterial thrombectomy (IAT) has recently been recommended as favorable treatment option to ensure that the thrombolytic effect is delivered to the affected region for acute ischemic stroke patients. The current American Heart and Stroke Associations’ (AHA/ASA) guidelines recommend with level of evidence A that “patients should receive mechanical thrombectomy with a stent retriever if they meet all the following criteria: (1) pre-stroke modified Rankin Scale (mRS) score of 0 to 1; (2) causative occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA) segment 1 (M1); (3) age ≥ 18 years; (4) National Institute of Health Stroke Scale (NIHSS) score ≥ 6; (5) Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6; and (6) treatment can be initiated (groin puncture) within 6 hours of symptom onset.”. More evidence is still needed to ascertain whether IVT prior to IAT is superior to IAT alone, or whether there are any surrogate baseline markers that may predict patients’ functional outcomes at earlier time points
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