Chushuang Chen1, Mark W Parsons2, Christopher R Levi2, Neil J Spratt2, Ferdinand Miteff2, Longting Lin2, Xin Cheng2, Min Lou2, Tim Kleinig2, Kenneth Butcher2, Qiang Dong2, Andrew Bivard2. 1. From the Department of Neurology (C.C., C.R.L., N.J.S., F.M., L.L.), John Hunter Hospital; University of Newcastle (C.C., C.R.L., N.J.S., F.M., L.L.); Hunter Medical Research Institute (C.C., C.R.L., N.J.S., F.M., L.L.), Newcastle; Department of Neurology (M.W.P., A.B.), Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Australia; Department of Neurology (X.C., Q.D.), Huashan Hospital, Fudan University, Shanghai; Department of Neurology (M.L.), Second Affiliated Hospital of Zhejiang University, Hangzhou, China; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; and Division of Neurology (K.B.), Department of Medicine, University of Alberta, Edmonton, Canada. chushuang.chen@uon.edu.au. 2. From the Department of Neurology (C.C., C.R.L., N.J.S., F.M., L.L.), John Hunter Hospital; University of Newcastle (C.C., C.R.L., N.J.S., F.M., L.L.); Hunter Medical Research Institute (C.C., C.R.L., N.J.S., F.M., L.L.), Newcastle; Department of Neurology (M.W.P., A.B.), Royal Melbourne Hospital, Melbourne Brain Centre, University of Melbourne, Australia; Department of Neurology (X.C., Q.D.), Huashan Hospital, Fudan University, Shanghai; Department of Neurology (M.L.), Second Affiliated Hospital of Zhejiang University, Hangzhou, China; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; and Division of Neurology (K.B.), Department of Medicine, University of Alberta, Edmonton, Canada.
Abstract
OBJECTIVE: To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). METHODS: EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes. RESULTS: From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0-1 odds ratio 0.01, p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals (p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0-1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008). CONCLUSION: From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
OBJECTIVE: To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). METHODS:EVT-Rpatients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-Rpatients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-Rpatients within quintiles of increasing baseline ischemic core and penumbral volumes. RESULTS: From INSPIRE, there were 141 EVT-Rpatients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core <30 mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0-1 odds ratio 0.01, p < 0.001). The group with a baseline core <30 mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals (p = 0.01). In patients with a baseline ischemic core volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0-1 odds ratio 1.61, p < 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core >30 mL (20% vs 3% in EVT-R, p = 0.008). CONCLUSION: From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.