In-Hospital Intravenous Thrombolysis Offers No Benefit in Mechanical Thrombectomy in Optimized Tertiary Stroke Center Setting

Juha-Pekka Pienimäki, Jyrki Ollikainen, Niko Sillanpää, Sara Protto

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Purpose: Mechanical thrombectomy (MT) is the first-line treatment in acute stroke patients presenting with large vessel occlusion (LVO). The efficacy of intravenous thrombolysis (IVT) prior to MT is being contested. The objective of this study was to evaluate the efficacy of MT without IVT in patients with no contraindications to IVT presenting directly to a tertiary stroke center with acute anterior circulation LVO. Materials and Methods: We collected the data of 106 acute stroke patients who underwent MT in a single high-volume stroke center. Patients with anterior circulation LVO eligible for IVT and directly admitted to our institution who subsequently underwent MT were included. We recorded baseline clinical, laboratory, procedural, and imaging variables and technical, imaging, and clinical outcomes. The effect of intravenous thrombolysis on 3-month clinical outcome (mRS) was analyzed with univariate tests and binary and ordinal logistic regression analysis. Results: Fifty-eight out of the 106 patients received IVT + MT. These patients had 2.6-fold higher odds of poorer clinical outcome in mRS shift analysis (p = 0.01) compared to MT-only patients who had excellent 3-month clinical outcome (mRS 0–1) three times more often (p = 0.009). There were no significant differences between the groups in process times, mTICI, or number of hemorrhagic complications. A trend of less distal embolization and higher number of device passes was observed among the MT-only patients. Conclusions: MT without prior IVT was associated with an improved overall three-month clinical outcome in acute anterior circulation LVO patients.

Original languageEnglish
Pages (from-to)580–586
JournalCARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY
Volume44
Issue number4
Early online date2020
DOIs
Publication statusPublished - 2021
Publication typeA1 Journal article-refereed

Keywords

  • Intravenous thrombolysis
  • Ischemic stroke
  • Mechanical thrombectomy

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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