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E-109 Combined intra-venous and intra-arterial thrombolysis versus intra-venous thrombolysis alone in stroke patients underwent mechanical thrombectomy: a propensity-matched analysis
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  1. R Abo Kasem1,
  2. S Elawady1,
  3. B Mulpur2,
  4. H Matsukawa1,3,
  5. C Cunningham1,
  6. M Sowlat1,
  7. A Orscelik4,
  8. N Nawabi1,
  9. J Isidor1,
  10. I Maier5,
  11. P Jabbour6,
  12. J Kim7,
  13. S Wolfe8,
  14. A Rai9,
  15. R Starke10,
  16. M Psychogios11,
  17. E Samaniego12,
  18. S Yoshimura13,
  19. H Cuellar14,
  20. B Howard15,
  21. A Alawieh15,
  22. A Alaraj16,
  23. M Ezzeldin17,
  24. D Romano18,
  25. O Tanweer19,
  26. J Mascitelli20,
  27. I Fragata21,
  28. A Polifka22,
  29. F Siddiqui23,
  30. J Osbun24,
  31. R Grandhi25,
  32. R Crosa26,
  33. C Matouk27,
  34. M Park28,
  35. M Levitt29,
  36. W Brinjikji30,
  37. M Moss31,
  38. E Daglioglu32,
  39. R Williamson33,
  40. P Navia34,
  41. P Kan35,
  42. R De Leacy36,
  43. S Chowdhry37,
  44. D Altschul38,
  45. A Spiotta1,
  46. N Goyal39
  1. 1Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC
  2. 2Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, TN
  3. 3Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
  4. 4Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, San Francisco, CA
  5. 5Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
  6. 6Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA
  7. 7Neurology, Chonnam National University Medical School, Gwangju, Korea, Republic of
  8. 8Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
  9. 9Neurosurgery, West Virginia School of Medicine, Morgantown, WV
  10. 10Neurosurgery, University of Miami Health System, Miami, FL
  11. 11Interventional and Diagnostical Neuroradiology, University of Basel, Basel, Switzerland
  12. 12Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA
  13. 13Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
  14. 14Neurosurgery and Neurointerventional Radiology, Louisiana State University, Shreveport, LA
  15. 15Neurosurgery, Emory University, Atlanta, GA
  16. 16Neurosurgery, University of Chicago at Illinois, Chicago, IL
  17. 17Clinical Neuroscience, University of Houston, HCA Houston Healthcare Kingwood, Kingwood, TX
  18. 18Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy, Salerno SA, Italy
  19. 19Neurosurgery, Baylor College of Medicine, Houston, TX
  20. 20Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
  21. 21Department of Neuroradiology, Hospital São José Centro Hospitalar, Portugal, Lisboa Portugal
  22. 22Neurosurgery, University of Florida, Gainesville, USA, Gainesville, FL
  23. 23Neuroscience, University of Michigan Health West, Michigan, USA, Wyoming, MI
  24. 24Neurological Surgery, Washington University, St Louis, Missouri, USA, St. Louis, MO
  25. 25Neurosurgery, University of Utah, Salt Lake City, UT
  26. 26Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay
  27. 27Neurosurgery, Yale School of Medicine, New Haven, CT
  28. 28Neurosurgery, University of Virginia, Charlottesville, VA
  29. 29Neurosurgery, University of Washington, USA, Seattle, WA
  30. 30Radiology, Neurosurgery, Mayo Clinic, Rochester, MN
  31. 31Neuroradiology, Washington Regional J.B. Hunt Transport Services Neuroscience Institute, Fayetteville, AZ
  32. 32Neurosurgery, Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey
  33. 33Neurosurgery, Allegheny Health Network, Pittsburgh, PA
  34. 34Neuroradiology, Hospital Universitario La Paz, Madrid, Spain
  35. 35Neurological Surgery, University of Texas Medical Branch, Galveston, TX
  36. 36Neurosurgery, Mount Sinai Health System, New York, NY
  37. 37Neurosurgery, NorthShore University Health System, Evanston, IL
  38. 38Neurological Surgery, Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
  39. 39Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis, USA, Memphis, TN

Abstract

Introduction Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) combining intravenous (IV) or intra-arterial (IA) thrombolysis has been studied recently. However, no study has explored the outcomes of combining both IV and IA thrombolysis with MT.

Methods Data from Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023 was utilized. We compared AIS patients with LVO who underwent MT and combined IVT and IAT with those who underwent MT with IVT only. We performed propensity score (PS) matching between the two groups using age, sex, premorbid mRS, admission NIHSS, occluded vessel, ASPECTS score, time from symptoms onset to arterial puncture, and frontline technique. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement, any ICH, mRS 0–1, and 90-day mortality.

Results A total of 2495 LVO-related AIS patients were included, consisting of the IA+IV group (n = 266) and the IV group (n = 2228). Propensity matching yielded 192 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.61–1.52, p = 0.60; OR: 0.92, 95% CI:0.42–2.03, p > 0.90, respectively). The IA+IV group had a significantly lower proportion of successful recanalization (OR:0.41, 95% CI: 0.27–0.62, p < 0.001), and early neurological improvement (OR: 0.55, 95% CI: 0.30–1.00). However, 90-daymRS 0–2, mRS 0–1, and mortality rates showed no significant differences between the two groups.

Conclusion This study suggests that the combined use of IAT and IVT in AIS patients undergoing MT is safe. Although the MT+IVT+IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the MT+IVT group, indicating a potential delayed benefit of additional IAT therapy.

Disclosures R. Abo Kasem: None. S. Elawady: None. B. Mulpur: None. H. Matsukawa: None. C. Cunningham: None. M. Sowlat: None. A. Orscelik: None. N. Nawabi: None. J. Isidor: None. I. Maier: 3; C; speakers’ honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. S. Yoshimura: 6; C; received lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention Inc, Medtronic Inc. Educational/Research Grants: Q’apel Inc, Steinberg Foundation. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. M. Park: 2; C; Consultant for Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereota. W. Brinjikji: 1; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He rec. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Syn. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 2; C; Consultant for MicroVention, Stryker, and Cerenovus. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus. N. Goyal: None.

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