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  • Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy

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Ischemic Stroke
Original research
Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy
  1. Nitin Goyal1,2,
  2. Georgios Tsivgoulis3,
  3. Abhi Pandhi1,
  4. Konark Malhotra4,
  5. Rashi Krishnan1,
  6. Muhammad F Ishfaq1,
  7. Balaji Krishnaiah1,
  8. Christopher Nickele2,
  9. Violiza Inoa-Acosta2,
  10. Aristeidis H Katsanos5,
  11. Daniel Hoit2,
  12. Lucas Elijovich2,
  13. Andrei Alexandrov6,
  14. Adam S Arthur2
  1. 1 Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2 Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis, Tennesseee, United States
  3. 3 Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Athens, Greece
  4. 4 West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia, USA
  5. 5 Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
  6. 6 Department of Neurology, University of Tennessee, Memphis, Memphis, Tennessee, USA
  1. Correspondence to Dr Nitin Goyal, Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA; ngoyal{at}uthsc.edu

Abstract

Introduction We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center.

Methods Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented.

Results A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8% vs 62.9%; p=0.023) and 3-month functional independence (modified Rankin Scale score 0–2;51.6% vs 38.2%; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33–70) vs 70 (IQR 44–98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1–1) vs 2 (IQR 1–2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98% vs 77%; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95% CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient −20.39; 95% CI −27.56 to –13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95% CI 4.46 to 48.00; p<0.001).

Conclusions IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.

  • stroke
  • thrombectomy
  • thrombolysis

https://doi.org/10.1136/neurintsurg-2019-014746

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    Footnotes

    • Contributors NG: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. GT, AHK: analysis and interpretation, critical revision of the manuscript for important intellectual content. AP, RK, MFI: acquisition of data, critical revision of the manuscript for important intellectual content. KM, BK, CN, VI-A, DH, LE, AA: critical revision of the manuscript for important intellectual content. ASA: study supervision, critical revision of the manuscript for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.