Background No randomized trial has investigated the effect of mechanical thrombectomy (MT) alone in patients with acute stroke. There are conflicting results as to whether prior intravenous thrombolysis (IVT) facilitates subsequent MT, and data in patients treated with MT alone owing to contraindications to IVT are limited.
Objective To compare consecutive patients treated with MT alone or with preceding IVT in a large tertiary neurointerventional center, with special emphasis on contraindications to IVT.
Methods Retrospective analysis of 283 consecutive patients with acute ischemic stroke treated with MT in a tertiary neurovascular center over 14 months. Data on characteristics of periprocedural times, recanalization rate, complications, and long-term functional outcome were collected prospectively.
Results Information on prior IVT and functional outcome was available in 250 patients. Mean (SD) follow-up period was 5.7 (5.1) months and 105 (42%) patients received both IVT and MT. No significant differences were found in successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) 2b/3, 73.8% vs 73.1, p=0.952), complication rates, and long-term favorable outcome (modified Rankin Scale 0–2, 35.2% vs 40%, p=0.444) between patients receiving MT plus IVT and those receiving MT alone. A favorable outcome in patients directly treated with MT alone who were eligible for IVT was achieved in 48.2%. Thrombectomy was safe and resulted in a favorable outcome in 32% of patients with absolute contraindications to IVT.
Conclusions Preceding use of IVT was not an independent predictor of favorable outcome in patients with acute stroke treated with MT and complication rates did not differ whether or not IVT was used. MT is safe and achieved a favorable outcome in one-third of patients with stroke ineligible for IVT.
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Contributors RW was involved in the design of the study, monitored data collection for the whole study, acquired patient data, wrote the statistical analysis plan, analyzed and interpreted the data, drafted and revised the paper. He is guarantor. HN was involved in the design of in the design of the study and patient data acquisition, analyzed and interpreted data, and revised the draft paper. JH wrote the statistical analysis plan, collected, analysed, and interpreted data, and revised the draft paper. MH, MS, and PS collected, analysed, and interpreted data and revised the draft paper. KB was involved in the design of the study, monitored data collection, analyzed and interpreted data, and revised the draft paper. RC was involved in the design of the study, analyzed and interpreted data and revised the draft paper.
Competing interests RW received speaker honoria from Covidien and Boeheringer Ingelheim and from serving on a scientific advisory board of Covidien. HN received speaker honoria from Covidien and Microvention. PS received consulting fees from Acandis and Covidien, speaker honoraria from Microvention, and proctering agreement from Balt and Microvention. RC received consulting fee or speaker honoria from Balt, Medtronic/Covidien, Microvention, Neuravi, Siemens and Stryker.
Ethics approval Ethics committees of the Chambers of Physicians of Westphalia and Northrhine, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data discussed in this article are taken from our institution. Unpublished anonymized data may be available on request to the corresponding author.