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BackgroundCombination of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is still the standard of care for select patients with acute large vessel occlusion (LVO) stroke within 4.5-hours of last known well (LKW). However, the impact of bridging therapy on clinical outcomes for eligible patients who present directly to comprehensive stroke centers (CSC) remains controversial.MethodsThis is a retrospective cohort obtained from Get With The Guidelines-Stroke Database available at the Medical University of South Carolina CSC for LVO patients who presented within 4.5-hours-of-LKW between January/2018 and June/2022. This study aimed to evaluate the benefit of IVT in reducing the final infarction volume (FIV) after complete recanalization.ResultsOf 220 patients who presented with LVO and had complete recanalization (mTICI2c/3), 100 (45%) arrived within 4.5 hours of LKW and 39 patients (39%) received IVT in addition to mechanical thrombectomy (IVT-MT). IVT-MT group had a smaller final infarct volume (FIV) than the MT-only group (7cc vs.16 cc, p=0.03). IVT was associated with 26cc reduction in FIV 95%CI [-45.7, -6.80), p=0.009). This effect was modified by the Collaterals score for anterior LVO 11cc 95%CI [-20.33- -1.92]. FIV influenced discharge NIHSS 3.095 95%CI [0.030-0.136], p= 0.003, and 90-day functional independence mRS (0-2) aOR 0.98 95%CI [0.96-0.99], p=0.022. Consequently, the IV-MT group had better 24-hours NIHSS 2 IQR (0-5) vs. 6 (2-13) p= 0.034, better discharge NIHSS 2 IQR (0-2) vs. 4 (1-11) p= 0.048, and more proportion of patients achieved functional independence at 90-days 32% vs. 10% however this difference did not reach statistical significance p=0.41.ConclusionThis study suggests that the combined IVT-MT approach can benefit LVO patients beyond the drip and ship model. IVT potentiates the effect of successful recanalization via the reduction of FIV and subsequent improved outcomes |
