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  • Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

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Ischemic Stroke
Original research
Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis2,
  3. Jason J Chang3,
  4. Konark Malhotra4,
  5. Juan Goyanes1,
  6. Abhi Pandhi1,
  7. Rashi Krishnan5,
  8. Muhammad F Ishfaq1,
  9. Daniel Hoit6,
  10. Christopher Nickele7,
  11. Violiza Inoa-Acosta8,
  12. Aristeidis H Katsanos9,
  13. Lucas Elijovich10,
  14. Andrei Alexandrov11,
  15. Adam S Arthur12
  1. 1 Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2 Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Athens, Greece
  3. 3 Critical Care, MedStar Washington Hospital Center, Washington, District of Columbia, USA
  4. 4 West Virginia University Health Sciences Center Charleston Division, Charleston, West Virginia, USA
  5. 5 Neurology, University of Tennessee Health Science Center, College of Medicine Memphis, Memphis, Tennessee, USA
  6. 6 Neurosurgery, University of Tennessee, Memphis, Tennessee, USA
  7. 7 UTHSC, Department of Neurosurgery, Memphis, Tennessee, USA
  8. 8 Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  9. 9 Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
  10. 10 Semmes-Murphey Clinic, Memphis, Tennessee, USA
  11. 11 Surgery, University of Alabama, Birmingham, Alabama, Alabama, USA
  12. 12 UT Department of Neurosurgery/Semmes-Murphey Clinic, 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 One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).

Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.

Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.

Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).

Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

  • stroke
  • thrombectomy
  • thrombolysis

https://doi.org/10.1136/neurintsurg-2019-014935

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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. JJC, KM, DH, CN, VI-A, LE, AA: critical revision of the manuscript for important intellectual content. JG, AP, RK, MFI: acquisition of data, 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.

    • Ethics approval The study was approved by the university of Tennessee institutional review board (15-04168-XP). Considering the retrospective nature, the board waived the need for the patient’s consent.

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

    • Patient consent for publication Not required.