Journal article
Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis
Journal of neurointerventional surgery, Vol.17(e2), pp.e261-e268
05/2025
DOI: 10.1136/jnis-2024-021975
PMID: 39179373
Abstract
A combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.BACKGROUNDA combination of intravenous (IVT) or intra-arterial (IAT) thrombolysis with mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion (AIS-LVO) has been investigated. However, there is limited data on patients who receive both IVT and IAT compared with IVT alone before MT.STAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.METHODSSTAR data from 2013 to 2023 was utilized. We performed propensity score matching between the two groups. The primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) score 0-2. Secondary outcomes included successful recanalization (modified treatment in cerebral infarction (mTICI) ≥2B, ≥2C), early neurological improvement, any intracranial hemorrhage (ICH), and 90-day mortality.A total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).RESULTSA total of 2454 AIS-LVO patients were included. Propensity matching yielded 190 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio (OR): 0.80, 95% confidence interval (CI) 0.51-1.24, P=0.37; OR: 0.60, 95% CI 0.29 to 1.24, P=0.21, respectively). Rates of successful recanalization and early neurological improvement (ENI) were significantly lower in MT+IVT + IAT. mRS 0-1 and mortality were not significantly different between the two groups. However, the MT+IVT + IAT group demonstrated superior rates of good functional outcomes (90-day mRS 0-1) compared with patients in the MT+IVT group who had mTICI ≤2B, (OR: 2.18, 95% CI 1.05 to 3.99, P=0.04).The combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.CONCLUSIONThe combined use of IAT and IVT thrombolysis in AIS-LVO patients undergoing MT is safe. Although the MT+IVT+ IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes were favorable in this group suggesting a potential delayed benefit of IAT.
Details
- Title: Subtitle
- Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis
- Creators
- Sameh Samir Elawady - Medical University of South CarolinaRahim Abo Kasem - Medical University of South CarolinaBhageeradh Mulpur - University of Tennessee Health Science CenterConor Cunningham - Medical University of South CarolinaHidetoshi Matsukawa - Medical University of South CarolinaMohammad-Mahdi Sowlat - Medical University of South CarolinaAtakan Orscelik - University of California, San FranciscoNoah L A Nawabi - Medical University of South CarolinaJulio Isidor - Medical University of South CarolinaIlko MaierPascal Jabbour - Thomas Jefferson UniversityJoon-Tae Kim - Chonnam National UniversityStacey Q Wolfe - Wake Forest UniversityAnsaar Rai - West Virginia University HospitalsRobert M Starke - University of MiamiMarios-Nikos Psychogios - University of BaselEdgar A Samaniego - University of IowaShinichi Yoshimura - Hyogo Medical UniversityHugo Cuellar - Louisiana State University Health Sciences Center ShreveportBrian M Howard - Emory UniversityAli Alawieh - Emory UniversityAli Alaraj - University of Illinois ChicagoMohamad Ezzeldin - University of HoustonDaniele G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaOmar Tanweer - Baylor College of MedicineJustin R Mascitelli - The University of Texas Health Science Center at San AntonioIsabel Fragata - Unidade Local de Saúde de São JoséAdam J Polifka - University of FloridaFazeel SiddiquiJoshua W Osbun - Washington University in St. LouisRamesh Grandhi - University of UtahRoberto Javier CrosaCharles Matouk - Yale UniversityMin S Park - University of VirginiaWaleed Brinjikji - Mayo ClinicMark Moss - Washington Regional Medical CenterErgun Daglioglu - Ankara Bilkent City HospitalRichard Williamson - Allegheny Health NetworkPedro Navia - Hospital Universitario La PazPeter Kan - The University of Texas Medical Branch at GalvestonReade Andrew De Leacy - Icahn School of Medicine at Mount SinaiShakeel A Chowdhry - NorthShore University HealthSystemDavid Altschul - Montefiore Medical CenterAlejandro M Spiotta - Medical University of South CarolinaMichael R Levitt - University of WashingtonNitin Goyal - University of Tennessee Health Science Center
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.17(e2), pp.e261-e268
- DOI
- 10.1136/jnis-2024-021975
- PMID
- 39179373
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8486
- eISSN
- 1759-8486
- Publisher
- BMJ PUBLISHING GROUP
- Grant note
This study was supported in STAR that receive research support from Penumbra, Microvention, Medtronic, Stryker, Rapid AI, and Brain Aneurysm Foundation. The funding sources did not participate in any part of the study, from study conception to manuscript preparation. DAS:Data are available upon reasonable request. NA.
- Language
- English
- Electronic publication date
- 08/23/2024
- Date published
- 05/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984699524102771
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