Nitin Goyal1, Georgios Tsivgoulis1, Donald Frei1, Aquilla Turk1, Blaise Baxter1, Michael T Froehler1, J Mocco1, Abhi Pandhi1, Ramin Zand1, Konark Malhotra1, Daniel Hoit1, Lucas Elijovich1, David Loy1, Raymond D Turner1, Justin Mascitelli1, Kiersten Espaillat1, Aristeidis H Katsanos1, Anne W Alexandrov1, Andrei V Alexandrov1, Adam S Arthur2. 1. From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), "Attikon University Hospital," School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis. 2. From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), "Attikon University Hospital," School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis. aarthur@semmes-murphey.com.
Abstract
OBJECTIVE: In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. METHODS: Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. RESULTS: A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95% CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26-0.96). CONCLUSIONS: This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.
OBJECTIVE: In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients. METHODS: Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0-2 at 3 months], favorable functional outcome [mRS of 0-1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score-matched analyses were performed. RESULTS: A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02-2.99) and functional improvement (common OR 1.64; 95% CI 1.05-2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26-0.96). CONCLUSIONS: This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for strokepatients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.
Authors: Nitin Goyal; Georgios Tsivgoulis; Konark Malhotra; Muhammad F Ishfaq; Abhi Pandhi; Michael T Frohler; Alejandro M Spiotta; Mohammad Anadani; Marios Psychogios; Volker Maus; Adnan Siddiqui; Muhammad Waqas; Peter D Schellinger; Marcel Groen; Christos Krogias; Daniel Richter; Maher Saqqur; Pablo Garcia-Bermejo; Maxim Mokin; Ronen Leker; Jose E Cohen; Aristeidis H Katsanos; Georgios Magoufis; Klearchos Psychogios; Vasileios Lioutas; Meg VanNostrand; Vijay K Sharma; Maurizio Paciaroni; Alexandros Rentzos; Hazem Shoirah; J Mocco; Christopher Nickele; Violiza Inoa; Daniel Hoit; Lucas Elijovich; Andrei V Alexandrov; Adam S Arthur Journal: JAMA Neurol Date: 2020-01-01 Impact factor: 18.302
Authors: Kilian M Treurniet; Natalie E LeCouffe; Manon Kappelhof; Yvo B W E M Roos; Charles B L M Majoie; Bart J Emmer; Adriaan C G M van Es; Jelis Boiten; Geert J Lycklama; Koos Keizer; Lonneke S F Yo; Hester F Lingsma; Wim H van Zwam; Inger de Ridder; Robert J van Oostenbrugge; Aad van der Lugt; Diederik W J Dippel; Jonathan M Coutinho Journal: Trials Date: 2021-02-15 Impact factor: 2.279
Authors: Ilko L Maier; Andreas Leha; Mostafa Badr; Ibrahim Allam; Mathias Bähr; Ala Jamous; Amelie Hesse; Marios-Nikos Psychogios; Daniel Behme; Jan Liman Journal: Front Neurol Date: 2021-06-10 Impact factor: 4.003