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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Georgios Tsivgoulis; Aristeidis H Katsanos; Dimitris Mavridis; Anne W Alexandrov; Georgios Magoufis; Adam Arthur; Valeria Caso; Peter D Schellinger; Andrei V Alexandrov Journal: Ther Adv Neurol Disord Date: 2016-12-01 Impact factor: 6.570
Authors: Johannes Kaesmacher; Christian Maegerlein; Felix Zibold; Silke Wunderlich; Claus Zimmer; Benjamin Friedrich Journal: Eur Radiol Date: 2017-07-27 Impact factor: 5.315
Authors: James Wareham; Sebastian Luppe; Adam Youssef; Robert Crossley; Alex Mortimer Journal: Interv Neuroradiol Date: 2018-06-05 Impact factor: 1.610
Authors: Lars Kellert; Frank Arne Wollenweber; Götz Thomalla; Christian H Nolte; Jens Fiehler; Peter Arthur Ringleb; Franziska Dorn Journal: Eur Stroke J Date: 2017-08-17
Authors: Ronen R Leker; Jose E Cohen; David Tanne; David Orion; Gregory Telman; Guy Raphaeli; Jacob Amsalem; Jonathan Y Streifler; Hen Hallevi; Pavel Gavriliuc; Natan M Bornstein; Anat Horev; Nour Eddine Yaghmour Journal: Interv Neurol Date: 2018-07-04