Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke
Corresponding Author
Julian Maingard
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Correspondence
Julian Maingard, Department of Radiology, Austin Hospital, 145 Studley Road, Heidelberg, Vic. 3084, Australia.
Email: [email protected]
Search for more papers by this authorYasmin Shvarts
Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorRonan Motyer
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorVincent Thijs
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Department of Neurology, Austin Health, Melbourne, Victoria, Australia
Search for more papers by this authorPaul Brennan
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorAlan O'Hare
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorSeamus Looby
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorJohn Thornton
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorJoshua A. Hirsch
Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorChristen D. Barras
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorRonil V. Chandra
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Imaging, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorMark Brooks
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorHamed Asadi
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Imaging, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorHong K. Kok
Interventional Radiology, Department of Radiology, Northern Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
Julian Maingard
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Correspondence
Julian Maingard, Department of Radiology, Austin Hospital, 145 Studley Road, Heidelberg, Vic. 3084, Australia.
Email: [email protected]
Search for more papers by this authorYasmin Shvarts
Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorRonan Motyer
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorVincent Thijs
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Department of Neurology, Austin Health, Melbourne, Victoria, Australia
Search for more papers by this authorPaul Brennan
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorAlan O'Hare
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorSeamus Looby
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorJohn Thornton
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland
Search for more papers by this authorJoshua A. Hirsch
Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Search for more papers by this authorChristen D. Barras
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorRonil V. Chandra
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Imaging, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorMark Brooks
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorHamed Asadi
Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
Interventional Neuroradiology Unit, Monash Imaging, Monash Health, Melbourne, Victoria, Australia
Department of Imaging, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorHong K. Kok
Interventional Radiology, Department of Radiology, Northern Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Background
Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke is now current best practice.
Aim
To determine if bridging intravenous (i.v.) alteplase therapy confers any clinical benefit.
Methods
A retrospective study of patients treated with EVT for LVO was performed. Outcomes were compared between patients receiving thrombolysis and EVT with EVT alone. Primary end-points were reperfusion rate, 90-day functional outcome and mortality using the modified Rankin Scale (mRS) and symptomatic intracranial haemorrhage (sICH).
Results
A total of 355 patients who underwent EVT was included: 210 with thrombolysis (59%) and 145 without (41%). The reperfusion rate was higher in the group receiving i.v. tissue plasminogen activator (tPA) (unadjusted odds ratio (OR) 2.2, 95% confidence interval (CI): 1.29–3.73, P = 0.004), although this effect was attenuated when all variables were considered (adjusted OR (AOR) 1.22, 95% CI: 0.60–2.5, P = 0.580). The percentage achieving functional independence (mRS 0–2) at 90 days was higher in patients who received bridging i.v. tPA (AOR 2.17, 95% CI: 1.06–4.44, P = 0.033). There was no significant difference in major complications, including sICH (AOR 1.4, 95% CI: 0.51–3.83, P = 0.512). There was lower 90-day mortality in the bridging i.v. tPA group (AOR 0.79, 95% CI: 0.36–1.74, P = 0.551).
Fewer thrombectomy passes (2 versus 3, P = 0.012) were required to achieve successful reperfusion in the i.v. tPA group. Successful reperfusion (modified thrombolysis in cerebral infarction ≥2b) was the strongest predictor for 90-day functional independence (AOR 10.4, 95% CI:3.6–29.7, P < 0.001).
Conclusion
Our study supports the current practice of administering i.v. alteplase before endovascular therapy.
References
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