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Original research
Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry
  1. Agathe Le Floch1,
  2. Frédéric Clarençon2,
  3. Aymeric Rouchaud3,4,
  4. Maeva Kyheng5,
  5. Julien Labreuche5,
  6. Igor Sibon6,
  7. Gregoire Boulouis7,
  8. Benjamin Gory8,
  9. Sébastien Richard9,
  10. Jildaz Caroff10,
  11. Raphaël Blanc11,
  12. Pierre Seners12,
  13. Omer F Eker13,
  14. Tae-Hee Cho14,
  15. Arturo Consoli15,
  16. Romain Bourcier16,
  17. benoit guillon17,
  18. Cyril Dargazanli18,
  19. Caroline Arquizan19,
  20. Christian Denier20,
  21. Francois Eugene21,
  22. Stephane Vannier22,
  23. Jean-Christophe Gentric23,
  24. Maxime Gauberti24,
  25. Olivier Naggara25,
  26. Charlotte Rosso26,
  27. Guillaume Turc27,
  28. Ozlem Ozkul-Wermester28,
  29. Christophe Cognard29,
  30. Jean François Albucher30,
  31. Serge Timsit31,
  32. Frederic Bourdain32,
  33. Anthony Le Bras33,34,
  34. Sebastian Richter35,
  35. Solène Moulin36,
  36. Raoul Pop37,
  37. Olivier Heck38,
  38. Ricardo Moreno39,
  39. Vincent L'Allinec40,
  40. Bertrand Lapergue41,
  41. Gaultier Marnat42
  42. on behalf of ETIS investigators
    1. 1 Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
    2. 2 Interventional neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
    3. 3 Interventional neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
    4. 4 CNRS, XLIM, UMR 7252, Université de Limoges, Limoges, Nouvelle-Aquitaine, France
    5. 5 Biostatistics, CHU Lille, Lille, Hauts-de-France, France
    6. 6 Neurology, CHU de Bordeaux, Bordeaux, France
    7. 7 Neuroradiology, CHRU Tours, Tours, Centre, France
    8. 8 Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
    9. 9 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
    10. 10 Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
    11. 11 Departement of interventional neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
    12. 12 Neurology, Fondation Rothschild, Paris, Île-de-France, France
    13. 13 Neuroradiology, Hospices Civils de Lyon, Bron, France
    14. 14 Neurology, CHU Lyon, Lyon, Auvergne-Rhône-Alpes, France
    15. 15 Interventional Neuroradiologie, Hopital Foch, Suresnes, Ile-de-France, France
    16. 16 Neuroradiology, Université de Nantes, Nantes, France
    17. 17 Stroke unit, CHU Nantes, Nantes, Pays de la Loire, France
    18. 18 Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
    19. 19 Neurology, CHU Montpellier, Montpellier, Languedoc-Roussillon, France
    20. 20 Neurology, Hopital Bicetre, Le Kremlin-Bicetre, France
    21. 21 Radiologie, CHU Rennes, Rennes, France
    22. 22 Department of Neurology, CHU Rennes, Rennes, Bretagne, France
    23. 23 Neuroradiology, CHU Brest, Brest, Bretagne, France
    24. 24 Neuroradiology, CHU Caen, Caen, Basse-Normandie, France
    25. 25 Neuroradiology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
    26. 26 Neurology, Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
    27. 27 Neurology, GHU Paris Pôle Neuro Sainte-Anne, Paris, Île-de-France, France
    28. 28 Neurology, CHU Rouen, Rouen, Normandie, France
    29. 29 Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, Occitanie, France
    30. 30 Neurology, University Hospital Centre Toulouse, Toulouse, Midi-Pyrénées, France
    31. 31 Neurology, CHU Brest, Brest, Bretagne, France
    32. 32 Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
    33. 33 Department of Radiology, Centre Hospitalier Bretagne Atlantique, Vannes, Bretagne, France
    34. 34 Neuroradiology, CHU Rennes Service de radiologie et d'imagerie médicale, Rennes, France
    35. 35 Neuroradiology, CH Pau, Pau, Aquitaine-Limousin-Poitou, France
    36. 36 Neurology, University Hospital Centre Reims, Reims, Champagne-Ardenne, France
    37. 37 Neuroradiolology, CHU Strasbourg, Strasbourg, Alsace, France
    38. 38 Neurology, CHU Grenoble Alpes, Grenoble, Auvergne-Rhone-Alpes, France
    39. 39 Department Of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
    40. 40 Département de Radiologie, CHU Angers, Angers, France
    41. 41 Stroke Center Neurology Division, Hopital Foch, SURESNES, France
    42. 42 Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
    1. Correspondence to Dr Gaultier Marnat, Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, 33000 Bordeaux, Aquitaine, France; gaultier.marnat{at}


    Background Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone.

    Methods We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0–2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients.

    Results Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004).

    Conclusions In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.

    • Stroke
    • Thrombectomy
    • Thrombolysis

    Data availability statement

    Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.

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    • Twitter @gboulouis, @jildazz, @vincelal

    • Collaborators ETIS investigators (see uploaded online supplemental appendix).

    • Contributors We attest that all authors have read and approved the submitted manuscript. All authors have made substantial contributions and have approved the final submitted version. GM is the guarantor.

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.