Abstract
Abstract TP192: Combined Intra-Venous and Intra-Arterial Thrombolysis versus Intra-Venous Thrombolysis Alone in Stroke Patients Undergoing Mechanical Thrombectomy for Large Vessel Occlusion: A Propensity-Matched Analysis
Stroke (1970), Vol.55(Suppl_1)
02/2024
DOI: 10.1161/str.55.suppl_1.TP192
Abstract
Abstract only Introduction: The combination of intravenous or intra-arterial thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) has been thoroughly investigated. However, no study has explored the outcomes of combining both intravenous and intra-arterial thrombolysis with MT. Methods: Data from Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023 was utilized. We compared AIS patients with LVO who underwent MT with combined intra-venous and intra-arterial thrombolysis (IV+IA) and with intra-venous thrombolysis alone (IV). We performed propensity score (PS) matching between the two groups using age, sex, premorbid mRS, admission NIHSS, occluded vessel, ASPECTS score, time from symptoms onset to arterial puncture, and frontline technique. Primary outcomes were any intracranial hemorrhage (ICH) and symptomatic ICH (sICH). Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement (defined as 4 or more points improvement in NIHSS score in 24 hours), 90-day modified Rankin Scale (mRS) 0-2, mRS 0-1, and mortality. Results: A total of 2495 LVO-related AIS patients were included, consisting of the IA+IV group (n = 266) and the IV group (n = 2228). Propensity matching yielded 192 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.61-1.52, p = 0.60; OR: 0.92, 95% CI: 0.42-2.03, p > 0.90, respectively). The IA+IV group had a significantly lower proportion of successful recanalization (OR: 0.41, 95% CI: 0.27-0.62, p < 0.001), and early neurological improvement (OR: 0.55, 95% CI: 0.30-1.00). However, 90-day mRS 0-2, mRS 0-1, and mortality rates showed no significant differences between the two groups. Conclusion: The findings of this study suggest that the combined use of IA and IV thrombolysis in AIS patients undergoing MT is safe. Although the IA+IV group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the IV-thrombolysis group, indicating a potential delayed benefit of additional IA thrombolysis therapy.
Details
- Title: Subtitle
- Abstract TP192: Combined Intra-Venous and Intra-Arterial Thrombolysis versus Intra-Venous Thrombolysis Alone in Stroke Patients Undergoing Mechanical Thrombectomy for Large Vessel Occlusion: A Propensity-Matched Analysis
- Creators
- Sameh Samir Elawady - University of CharlestonHidetoshi Matsukawa - Medical University of South CarolinaNitin Goyal - Semmes Murphey FoundationConor Cunningham - Medical University of South CarolinaMohammad Mahdi Sowlat - Medical University of South CarolinaSara Zandpazandi - University of CharlestonAtakan Orscelik - University of CharlestonIlko Maier - Nephrologisches Zentrum GoettingenSami Al Kasab - Medical University of South CarolinaBhageeradh Mulpur - Semmes Murphey FoundationPascal M Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National UniversityStacey C Quintero - Wake Forest Universityansaar rai - West Virginia UniversityRobert Starke - University of Miami Health SystemMarios Psychogios - University Hospital of BaselEdgar A Samaniego - University of IowaShinichi Yoshimura - Hyogo Medical UniversityHugo Cuellar - Louisiana State University Health Sciences Center ShreveportJonathan A Grossberg - Emory UniversityAli M Alawieh - Emory UniversityDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaOmar Tanweer - Baylor College of MedicineJustin Mascitelli - The University of Texas Health Science Center at San AntonioIsabel Fragata - Rua Dr Augusto Jose da Cunha, AlgesAdam Polifka - University of FloridaJoshua Osbun - Washington University in St. LouisRoberto Crosa - Administracion de los Servicios de Salud del EstadoCharles C Matouk - Yale UniversityMin S Park - University of VirginiaMichael Levitt - Seattle UniversityWaleed Brinjikji - Mayo Clinic in ArizonaMark Moss - Washington Regional Medical CenterTravis Dumont - University of ArizonaRichard Williamson - Allegheny General HospitalPedro Navia - Hospital Universitario La PazPeter Kan - The University of Texas Medical Branch at GalvestonReade A De Leacy - Mount Saint Vincent UniversityAlejandro M Spiotta - University of CharlestonShakeel A Chowdhry - NorthShore University HealthSystemMohamad Ezzeldin - University of Houston
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.55(Suppl_1)
- DOI
- 10.1161/str.55.suppl_1.TP192
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984557944902771
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