Background Endovascular intervention is an important treatment option for patients with acute ischemic stroke who are ineligible for intravenous thrombolysis or fail to respond to such therapy. Endovascular treatments include intra-arterial thrombolysis (IAT) and mechanical thrombectomy (MT). Limited data exists regarding the safety and efficacy of a combination approach using IAT and MT.
Objectives To assess the safety and efficacy of combined mechanical and IAT therapy compared to MT alone.
Methods Retrospective chart review was performed in 200 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2007 and 2011. 115 patients met inclusion criteria of MT alone versus combined MT and IAT. We compared outcome parameters between these two groups including discharge NIHSS, modified Rankin Score (mRS), rate of partial to complete recanalization (TIMI 2–3), symptomatic intracerebral hemorrhage, and all cause mortality.
Results A total of 115 patients underwent MT alone or received combined therapy. In the MT only group, mean age was 69±13.32 and median initial NIHSS was 17. Of the combined therapy group, 66±16 was the mean age and median initial NIHSS was 18.
Conclusions In our experience combination MT and IAT in the treatment of acute ischemic stroke had a trend toward higher recanalization rates and number of patients with clinical improvement, as well as, lower discharge NIHSS and higher percentage of independently ambulating patients discharged as compared to MT alone. Despite higher hemorrhage and slightly increased mortality rates, the combined therapy group trended toward better clinical outcomes.
Competing interests None.
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