The effect of intravenous thrombolysis in stroke patients with unsuccessful thrombectomy

被引：2

作者：

Elawady, Sameh Samir ^{[1
]}

Kasem, Rahim Abo ^{[1
]}

Matsukawa, Hidetoshi ^{[1
,2
]}

Cunningham, Conor ^{[1
]}

Sowlat, Mohamed Mahdi ^{[1
]}

Nawabi, Noah Lee ^{[1
]}

Orscelik, Atakan ^{[3
]}

Venegas, Joshua M. ^{[1
]}

Isidor, Julio ^{[1
]}

Loulida, Hasna ^{[1
]}

Maier, Ilko ^{[4
]}

Jabbour, Pascal ^{[5
]}

Kim, Joon-Tae ^{[6
]}

Wolfe, Stacey Quintero ^{[7
]}

Rai, Ansaar ^{[8
]}

Starke, Robert M. ^{[9
]}

Psychogios, Marios-Nikos ^{[10
]}

Samaniego, Edgar A. ^{[11
]}

Goyal, Nitin ^{[12
]}

Yoshimura, Shinichi ^{[3
]}

Cuellar, Hugo ^{[13
]}

Howard, Brian ^{[14
]}

Alawieh, Ali ^{[14
]}

Alaraj, Ali ^{[15
]}

Ezzeldin, Mohamad ^{[16
]}

Romano, Daniele G. ^{[17
]}

Tanweer, Omar ^{[18
]}

Mascitelli, Justin ^{[19
]}

Fragata, Isabel ^{[20
]}

Polifka, Adam ^{[21
]}

Siddiqui, Fazeel ^{[22
]}

Osbun, Joshua ^{[23
]}

Grandhi, Ramesh ^{[24
]}

Crosa, Roberto ^{[25
]}

Matouk, Charles ^{[26
]}

Park, Min S. ^{[27
]}

Levitt, Michael R. ^{[28
]}

Brinjikji, Waleed ^{[29
,30
]}

Moss, Mark ^{[31
]}

Daglioglu, Ergun ^{[32
]}

Williamson, Richard ^{[33
]}

Navia, Pedro ^{[34
]}

Kan, Peter ^{[35
]}

De Leacy, Reade ^{[36
]}

Chowdhry, Shakeel ^{[37
]}

Altschul, David J. ^{[38
,39
]}

Spiotta, Alejandro M. ^{[1
]}

Al Kasab, Sami ^{[1
]}

机构：

[1] Med Univ South Carolina, Dept Neurosurg, Div Neuroendovasc Surg, 96 Jonathan Lucas St, Charleston, SC 29425 USA

[2] Hyogo Med Univ, Dept Neurosurg, Nishinomiya, Japan

[3] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

[4] Univ Med Ctr Gottingen, Dept Neurol, Gottingen, Germany

[5] Thomas Jefferson Univ Hosp, Dept Neurosurg, Philadelphia, PA USA

[6] Chonnam Natl Univ, Chonnam Natl Univ Hosp, Dept Neurol, Med Sch, Gwangju, South Korea

[7] Wake Forest Sch Med, Dept Neurosurg, Winston Salem, NC USA

[8] West Virginia Sch Med, Dept Radiol, Morgantown, WV USA

[9] Univ Miami Hlth Syst, Dept Neurosurg, Miami, FL USA

[10] Univ Basel, Dept Intervent & Diag Neuroradiol, Basel, Switzerland

[11] Univ Iowa Hosp & Clin, Dept Neurol, Iowa City, IA USA

[12] Univ Tennessee Hlth Sci Ctr, Dept Neurosurg, Semmes Murphey Neurol & Spine Clin, Memphis, TN USA

[13] Louisiana State Univ, Dept Neurosurg & Neurointervent Radiol, Shreveport, LA USA

[14] Emory Univ, Neurosurg Radiol & Imaging Sci, Atlanta, GA USA

[15] Univ Chicago Illinois, Dept Neurosurg, Chicago, IL USA

[16] Univ Houston, Dept Clin Neurosci, HCA Houston Healthcare Kingwood, Kingwood, TX USA

[17] Univ Salerno, Univ Hosp San Giovanni Dio & Ruggi Aragona, Dept Neuroradiol, Salerno, Italy

[18] Baylor Coll Med, Dept Neurosurg, Houston, TX USA

[19] Univ Texas Hlth Sci Ctr San Antonio, Dept Neurosurg, San Antonio, TX USA

[20] Hosp Sao Jose Ctr Hosp, Dept Neuroradiol, Lisbon, Portugal

[21] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[22] Univ Michigan Hlth West, Dept Neurosci, Wyoming, MI USA

[23] Washington Univ, Dept Neurol Surg, St Louis, MO USA

[24] Univ Utah, Dept Neurosurg, Salt Lake City, UT USA

[25] Endovasc Neurol Ctr, Dept Neurosurg, Montevideo, Uruguay

[26] Yale Sch Med, Dept Neurosurg, New Haven, CT USA

[27] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA

[28] Univ Washington, Dept Neurosurg, Seattle, WA USA

[29] Mayo Clin, Dept Radiol, Rochester, MN USA

[30] Mayo Clin, Dept Neurosurg, Rochester, MN USA

[31] Arkansas Expt Stn, Fayetteville, AZ USA

[32] Hlth Sci Univ, Ankara Bilkent City Hosp, Dept Neurosurg, Ankara, Turkiye

[33] Allegheny Hlth Network, Dept Neurosurg, Pittsburgh, PA USA

[34] Univ Hosp La Paz, Dept Neuroradiol, Madrid, Spain

[35] Univ Texas Med Branch Galveston, Dept Neurol Surg, Galveston, TX USA

[36] Mt Sinai Hlth Syst, Dept Neurosurg, New York, NY USA

[37] NorthShore Univ Hlth Syst, Dept Neurosurg, Evanston, IL USA

[38] Albert Einstein Coll Med, Dept Neurol Surg, Bronx, NY USA

[39] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Cerebrovasc Res Lab, Bronx, NY USA

来源：

INTERVENTIONAL NEURORADIOLOGY | 2024年

关键词：

Stroke; thrombectomy; thrombolysis; LVO; ACUTE ISCHEMIC-STROKE; TISSUE-PLASMINOGEN ACTIVATOR; HEALTH-CARE PROFESSIONALS; SPONTANEOUS RECANALIZATION; HEMORRHAGIC TRANSFORMATION; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; ALTEPLASE; GUIDELINES; MANAGEMENT;

D O I：

10.1177/15910199241279009

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: The benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT). Methods: We included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score <= 2A). Patients who received IVT prior to MT were compared to those who received MT alone. Propensity score matching using demographic, clinical, radiographic and procedural variables was used to match patients with and without IVT. The primary outcome was favorable 90-day good functional outcome (defined as modified Rankin scale of 0-2), and secondary outcomes included intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality. Results: Totally, 610 AIS patients with unsuccessful MT were included. After propensity matching, 219 patients were identified in each group. Median age was 70 years and 73 years in the IVT + MT and MT alone groups, respectively. In the IVT + MT group, final mTICI scores of 0, 1, and 2A were achieved in 92 (42.0%), 33 (15.1%), and 94 (42.9%) patients, respectively, versus 76 (34.7%), 29 (13.2%), and 114 (52.1%) in the MT alone group. The IVT + MT group had greater odds of 90-day good functional outcome (adjusted odds ratio 2.54, 95% confidence interval 1.53-4.32). There were no significant differences in secondary outcomes. Conclusions: IVT is associated with improved functional outcomes in AIS patients with LVO despite unsuccessful MT.

引用

页数：10

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