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Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis
  1. Ralph Weber1,
  2. Hannes Nordmeyer2,
  3. Jeffrie Hadisurya1,
  4. Markus Heddier2,
  5. Michael Stauder2,
  6. Paul Stracke2,
  7. Klaus Berger3,
  8. Rene Chapot2
  1. 1Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany
  2. 2Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany
  3. 3Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
  1. Correspondence to Dr Ralph Weber, Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str 21, Essen 45131, Germany; ralph.weber{at}krupp-krankenhaus.de

Abstract

Background No randomized trial has investigated the effect of mechanical thrombectomy (MT) alone in patients with acute stroke. There are conflicting results as to whether prior intravenous thrombolysis (IVT) facilitates subsequent MT, and data in patients treated with MT alone owing to contraindications to IVT are limited.

Objective To compare consecutive patients treated with MT alone or with preceding IVT in a large tertiary neurointerventional center, with special emphasis on contraindications to IVT.

Methods Retrospective analysis of 283 consecutive patients with acute ischemic stroke treated with MT in a tertiary neurovascular center over 14 months. Data on characteristics of periprocedural times, recanalization rate, complications, and long-term functional outcome were collected prospectively.

Results Information on prior IVT and functional outcome was available in 250 patients. Mean (SD) follow-up period was 5.7 (5.1) months and 105 (42%) patients received both IVT and MT. No significant differences were found in successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) 2b/3, 73.8% vs 73.1, p=0.952), complication rates, and long-term favorable outcome (modified Rankin Scale 0–2, 35.2% vs 40%, p=0.444) between patients receiving MT plus IVT and those receiving MT alone. A favorable outcome in patients directly treated with MT alone who were eligible for IVT was achieved in 48.2%. Thrombectomy was safe and resulted in a favorable outcome in 32% of patients with absolute contraindications to IVT.

Conclusions Preceding use of IVT was not an independent predictor of favorable outcome in patients with acute stroke treated with MT and complication rates did not differ whether or not IVT was used. MT is safe and achieved a favorable outcome in one-third of patients with stroke ineligible for IVT.

  • Device
  • Stent
  • Stroke
  • Thrombectomy
  • Thrombolysis
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