Ilaria Casetta1, Giovanni Pracucci2, Andrea Saletti3, Valentina Saia4, Marina Padroni5, Alessandro De Vito5, Domenico Inzitari2, Andrea Zini6, Stefano Vallone7, Mauro Bergui8, Paolo Cerrato9,10, Sandra Bracco11, Rossana Tassi12, Roberto Gandini13, Fabrizio Sallustio14, Mariangela Piano2,15, Cristina Motto16, Paolino La Spina17, Sergio L Vinci18, Francesco Causin19, Claudio Baracchini20, Roberto Gasparotti21, Mauro Magoni22, Lucio Castellan23, Carlo Serrati24, Salvatore Mangiafico25, Danilo Toni26. 1. Neurological Clinic, S. Anna University Hospital of Ferrara, Italy. 2. NEUROFARBA Department, Neuroscience Section, University of Florence. 3. Interventional Neuroradiology, S. Anna University Hospital of Ferrara, Italy. 4. Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure. 5. Stroke Unit, S. Anna University Hospital of Ferrara, Italy. 6. Stroke Unit, Ospedale Civile "S.Agostino-Estense", Modena. 7. Neuroradiological Unit, Ospedale Civile "S.Agostino-Estense", Modena. 8. Interventional Neuroradiology Unit, Ospedale "Molinette", Torino. 9. Stroke Unit, Ospedale "Molinette", Torino. 10. Ospedale "Molinette", Torino. 11. Interventional Neuroradiology Unit, Siena University Hospital. 12. Stroke Unit, Siena University Hospital. 13. Interventional Neuroradiology Unit, Policlinico Tor Vergata, Rome. 14. Stroke Unit, Policlinico Tor Vergata, Rome. 15. Interventional Neuroradiology Unit, Niguarda Cà Granda" Hospital, Milan. 16. Stroke Unit, Niguarda Cà Granda" Hospital, Milan. 17. Stroke Unit, Policlinico G. Martino, Messina. 18. Interventional Neuroradiology Unit, Policlinico G. Martino, Messina. 19. Neuroradiology Unit, Padua University Hospital. 20. Stroke Unit, Padua University Hospital. 21. Neuroradiology Unit, Spedali Civili, Brescia. 22. Stroke Unit, Spedali Civili, Brescia. 23. Interventional Neuroradiology Unit, IRCCS S. Martino-IST, Genova. 24. Stroke Unit, IRCCS S. Martino-IST, Genova. 25. Interventional Neuroradiology Unit, "Careggi" University Hospital, Florence. 26. Stroke Unit, University Hospital "Umberto I", Rome.
Abstract
BACKGROUND: Whether mechanical thrombectomy alone may achieve better or at least equal clinical outcome than mechanical thrombectomy combined with intravenous thrombolysis is a matter of debate. METHODS: From the Italian Registry of Endovascular Stroke Treatment, we extracted all cases treated with intravenous thrombolysis followed by mechanical thrombectomy or with primary mechanical thrombectomy for anterior circulation stroke due to proximal vessel occlusion. We included only patients who would have qualified for intravenous thrombolysis. We compared outcomes of the two groups by using multivariate regression analysis and propensity score method. RESULTS: We included 1148 patients, treated with combined intravenous thrombolysis and mechanical thrombectomy therapy (n = 635; 55.3%), or with mechanical thrombectomy alone (n = 513; 44.7%). Demographic and baseline clinical characteristics did not differ between the two groups, except for a shorter onset to groin puncture time (p < 0.05) in the mechanical thrombectomy group. A shift in the 90-day modified Rankin Scale distributions toward a better outcome was found in favor of the combined treatment (adjusted common odds ratio = 1.3; 95% confidence interval: 1.04-1.66). Multivariate analyses on binary outcome show that subjects who underwent combined treatment had higher probability to survive with modified Rankin Scale 0-3 (odds ratio = 1.42; 95% confidence interval: 1.04-1.95) and lower case fatality rate (odds ratio = 0.6; 95% confidence interval: 0.44-0.9). Hemorrhagic transformation did not differ between the two groups. CONCLUSION: These data seem to indicate that combined intravenous thrombolysis and mechanical thrombectomy could be associated with lower probability of death or severe dependency after three months from stroke due to large vessel occlusion, supporting the current guidelines of treating eligible patients with intravenous thrombolysis before mechanical thrombectomy.
BACKGROUND: Whether mechanical thrombectomy alone may achieve better or at least equal clinical outcome than mechanical thrombectomy combined with intravenous thrombolysis is a matter of debate. METHODS: From the Italian Registry of Endovascular Stroke Treatment, we extracted all cases treated with intravenous thrombolysis followed by mechanical thrombectomy or with primary mechanical thrombectomy for anterior circulation stroke due to proximal vessel occlusion. We included only patients who would have qualified for intravenous thrombolysis. We compared outcomes of the two groups by using multivariate regression analysis and propensity score method. RESULTS: We included 1148 patients, treated with combined intravenous thrombolysis and mechanical thrombectomy therapy (n = 635; 55.3%), or with mechanical thrombectomy alone (n = 513; 44.7%). Demographic and baseline clinical characteristics did not differ between the two groups, except for a shorter onset to groin puncture time (p < 0.05) in the mechanical thrombectomy group. A shift in the 90-day modified Rankin Scale distributions toward a better outcome was found in favor of the combined treatment (adjusted common odds ratio = 1.3; 95% confidence interval: 1.04-1.66). Multivariate analyses on binary outcome show that subjects who underwent combined treatment had higher probability to survive with modified Rankin Scale 0-3 (odds ratio = 1.42; 95% confidence interval: 1.04-1.95) and lower case fatality rate (odds ratio = 0.6; 95% confidence interval: 0.44-0.9). Hemorrhagic transformation did not differ between the two groups. CONCLUSION: These data seem to indicate that combined intravenous thrombolysis and mechanical thrombectomy could be associated with lower probability of death or severe dependency after three months from stroke due to large vessel occlusion, supporting the current guidelines of treating eligible patients with intravenous thrombolysis before mechanical thrombectomy.
Authors: Ilaria Casetta; Enrico Fainardi; Giovanni Pracucci; Valentina Saia; Fabrizio Sallustio; Valerio da Ros; Sergio Nappini; Patrizia Nencini; Guido Bigliardi; Sergio Vinci; Francesco Grillo; Sandra Bracco; Rossana Tassi; Mauro Bergui; Paolo Cerrato; Andrea Saletti; Alessandro De Vito; Roberto Gasparotti; Mauro Magoni; Luigi Simonetti; Andrea Zini; Maria Ruggiero; Marco Longoni; Lucio Castellan; Laura Malfatto; Paola Castellini; Mirco Cosottini; Alessio Comai; Enrica Franchini; Emilio Lozupone; Giacomo Della Marca; Edoardo Puglielli; Alfonsina Casalena; Claudio Baracchini; Daniele Savio; Enrica Duc; Giuseppe Ricciardi; Manuel Cappellari; Luigi Chiumarulo; Marco Petruzzellis; Anna Cavallini; Nicola Cavasin; Adriana Critelli; Nicola Burdi; Giovanni Boero; Andrea Giorgianni; Maurizio Versino; Francesco Biraschi; Ettore Nicolini; Simone Comelli; Maurizio Melis; Riccardo Padolecchia; Tiziana Tassinari; Nunzio Paolo Nuzzi; Simona Marcheselli; Simona Sacco; Paolo Invernizzi; Ivan Gallesio; Delfina Ferrandi; Maria Fancello; Maria Valeria Saddi; Monia Russo; Aldo Pischedda; Antonio Baule; Marina Mannino; Francesco Florio; Vincenzo Inchingolo; Maria Elena Flacco; Daniele Romano; Umberto Silvagni; Domenico Inzitari; Salvatore Mangiafico; Danilo Toni Journal: Eur Stroke J Date: 2022-04-07
Authors: Jan Christoph Purrucker; Miriam Heyse; Simon Nagel; Christoph Gumbinger; Fatih Seker; Markus Möhlenbruch; Peter Arthur Ringleb Journal: Stroke Vasc Neurol Date: 2021-07-26