The role of intravenous thrombolysis in the endovascular treatment of acute anterior circulation vascular occlusive stroke

Abstract

Objective To investigate the effect and safety of intravenous thrombolytic therapy in the endovascular treatment of acute anterior circulation vascular occlusive stroke. Methods The clinical data of 226 patients with acute anterior circulation vascular occlusive stroke who underwent endovascular treatment in Nanjing First Hospital, Nanjing Medical University from May 2015 to May 2018 were retrospectively collected. According to whether or not intravenous thrombolysis was performed, the patients were classified into simple thrombectomy group (n=112) and bridging treatment group (n=114). The modified Thrombolysis in Cerebral Infarction Score (mTICI) was used to evaluate the vascular opening effect, and the blood vessel recanalization time, mTICI, the symptomatic intracranial hemorrhage rate, and the modified Rankin Scale (mRS) score at 90 days after surgery were evaluated. Results There were no statistically significant differences in gender, age, past history and National Institute of Health Stroke Scale score between the two groups (P>0.05). There was no statistically significant difference in door-to-recanalization time between the two groups (P>0.05). Excluding the patients with post-wake stroke and unexplained onset time, the simple thrombectomy group (n=63) and the bridging treatment group (n=111) showed statistically significant differences in onset-to-door time ((235.04±182.64) min vs (102.48±60.51) min, t=7.01, P 0.05). The differences in symptomatic intracranial hemorrhage rate (8.93% (10/112) vs 11.4% (13/114)), mortality rate (12.5% (12/112) vs 16.7% (19/114)) and 90-day good functional outcome (mRS score 0-2;54.5% (61/112) vs 55.8% (63/114)) between the two groups were not statistically significant (P>0.05). Conclusions In patients with acute anterior circulation vascular occlusive stroke undergoing endovascular treatment, intravenous thrombolysis can reduce the number of thrombectomy, not increase the door-to-recanalization time, the risk of symptomatic intracranial hemorrhage and mortality, and has similar good functional outcome as the simple thrombectomy group. Therefore, intravenous thrombolysis is safe and effective for endovascular treatment of acute anterior circulation large vessel occlusive stroke. Key words: Stroke; Thrombolytic therapy; Endovascular treatment; Stents