Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct.
Publication/Presentation Date
12-21-2023
Abstract
BACKGROUND: The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone.
METHODS: This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups.
RESULTS: A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes.
CONCLUSION: Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.
Volume
15
Issue
e3
First Page
414
Last Page
414
ISSN
1759-8486
Published In/Presented At
Anadani, M., Almallouhi, E., Maier, I., Al Kasab, S., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Samaniego, E. A., Arthur, A. S., Yoshimura, S., Cuellar, H., Howard, B. M., Alawieh, A., Fragata, I., Polifka, A. J., Mascitelli, J. R., Osbun, J. W., … Spiotta, A. M. (2023). Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct. Journal of neurointerventional surgery, 15(e3), e414–e418. https://doi.org/10.1136/jnis-2022-019537
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36990690
Department(s)
Administration and Leadership
Document Type
Article