The effect of intravenous thrombolysis in stroke patients with unsuccessful thrombectomy.
Publication/Presentation Date
10-1-2026
Abstract
BackgroundThe benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT).MethodsWe included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score ≤ 2A). Patients who received IVT prior to MT were compared to those who received MT alone. Propensity score matching using demographic, clinical, radiographic and procedural variables was used to match patients with and without IVT. The primary outcome was favorable 90-day good functional outcome (defined as modified Rankin scale of 0-2), and secondary outcomes included intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality.ResultsTotally, 610 AIS patients with unsuccessful MT were included. After propensity matching, 219 patients were identified in each group. Median age was 70 years and 73 years in the IVT + MT and MT alone groups, respectively. In the IVT + MT group, final mTICI scores of 0, 1, and 2A were achieved in 92 (42.0%), 33 (15.1%), and 94 (42.9%) patients, respectively, versus 76 (34.7%), 29 (13.2%), and 114 (52.1%) in the MT alone group. The IVT + MT group had greater odds of 90-day good functional outcome (adjusted odds ratio 2.54, 95% confidence interval 1.53-4.32). There were no significant differences in secondary outcomes.ConclusionsIVT is associated with improved functional outcomes in AIS patients with LVO despite unsuccessful MT.
Volume
32
Issue
5
First Page
2363
Last Page
2372
ISSN
2385-2011
Published In/Presented At
Elawady, S. S., Kasem, R. A., Matsukawa, H., Cunningham, C., Sowlat, M. M., Nawabi, N. L., Orscelik, A., Venegas, J. M., Isidor, J., Loulida, H., Maier, I., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Samaniego, E. A., Goyal, N., Yoshimura, S., … Al Kasab, S. (2026). The effect of intravenous thrombolysis in stroke patients with unsuccessful thrombectomy. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 32(5), 2363–2372. https://doi.org/10.1177/15910199241279009
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39262342
Department(s)
Administration and Leadership
Document Type
Article