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E-109 Combined intra-venous and intra-arterial thrombolysis versus intra-venous thrombolysis alone in stroke patients underwent mechanical thrombectomy: a propensity-matched analysis
Abstract   Peer reviewed

E-109 Combined intra-venous and intra-arterial thrombolysis versus intra-venous thrombolysis alone in stroke patients underwent mechanical thrombectomy: a propensity-matched analysis

R Abo Kasem, S Elawady, B Mulpur, H Matsukawa, C Cunningham, M Sowlat, A Orscelik, N Nawabi, J Isidor, I Maier, …
Journal of neurointerventional surgery, Vol.16(Suppl 1), pp.A150-A151
07/01/2024
DOI: 10.1136/jnis-2024-SNIS.214

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Abstract

Introduction Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) combining intravenous (IV) or intra-arterial (IA) thrombolysis has been studied recently. However, no study has explored the outcomes of combining both IV and IA 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 and combined IVT and IAT with those who underwent MT with IVT only. 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 symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement, any ICH, mRS 0–1, and 90-day 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-daymRS 0–2, mRS 0–1, and mortality rates showed no significant differences between the two groups. Conclusion This study suggests that the combined use of IAT and IVT in AIS patients undergoing MT is safe. Although the MT+IVT+IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the MT+IVT group, indicating a potential delayed benefit of additional IAT therapy.
 Stroke Aneurysms Equity stake Grants Mortality

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