Intravenous thrombolysis prior to mechanical thrombectomy does not affect clinical or procedural outcomes in patients with large vessel occlusion acute ischemic stroke.

Autor: Platko S; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States; Clinical Neuroscience Institute, Premier Health, Dayton OH, United States., Bensabeur F; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States; Clinical Neuroscience Institute, Premier Health, Dayton OH, United States., Rotsching N; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States., Wagner J; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States., Markert RJ; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States., Terry JB; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States; Clinical Neuroscience Institute, Premier Health, Dayton OH, United States., Cheng-Ching E; Department of Neurology, Wright State University Boonshoft School of Medicine, Dayton OH, United States; Clinical Neuroscience Institute, Premier Health, Dayton OH, United States. Electronic address: echeng@premierhealth.com.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2022 Jun; Vol. 100, pp. 120-123. Date of Electronic Publication: 2022 Apr 19.
DOI: 10.1016/j.jocn.2022.04.016
Abstrakt: Mechanical thrombectomy (MT) has revolutionized the care of large vessel occlusion acute ischemic strokes (LVOAIS). However, the benefit of intravenous thrombolysis prior to MT remains unproven. Two recent trials showed equivocal results regarding the benefits of pre-MT intravenous thrombolysis in predominantly Asian populations. We evaluated clinical outcomes and procedural metrics for patients with LVOAIS who were treated with MT alone compared to those who were treated with both intravenous tPA and MT. In a retrospective study, LVOAIS patients treated with MT, with or without preceding intravenous thrombolysis, between January of 2017 and December of 2019 were identified. Patients were treated according to contemporary guidelines. Baseline demographic and clinical characteristics, procedural metrics, and clinical outcomes were collected. Among LVOAIS patients, those treated with intravenous thrombolysis and MT did not differ from those with MT alone on clinical outcomes at three months. Further, the two groups did not differ on thrombectomy procedure times, recanalization rates, and symptomatic intracranial hemorrhage rates. In our patients with LVOAIS, intravenous thrombolysis combined with MT offered no advantage compared to MT alone in clinical outcomes or recanalization rates. Our results are consistent with earlier studies in other populations. In addition, our results suggest that IV tPA does not impact the ease of clot removal by MT. Further studies will evaluate how newly available thrombolytic agents may benefit patients eligible for MT.
(Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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