Comparison of combined intravenous and intra-arterial thrombolysis with intravenous thrombolysis alone in stroke patients undergoing mechanical thrombectomy: a propensity-matched analysis

被引：0

作者：

Elawady, Sameh Samir ^{[1
]}

Kasem, Rahim Abo ^{[1
]}

Mulpur, Bhageeradh ^{[2
]}

Cunningham, Conor ^{[1
]}

Matsukawa, Hidetoshi ^{[1
,3
]}

Sowlat, Mohammad-Mahdi ^{[1
]}

Orscelik, Atakan ^{[4
]}

Nawabi, Noah L. A. ^{[1
]}

Isidor, Julio ^{[1
]}

Maier, Ilko ^{[5
]}

Jabbour, Pascal ^{[6
]}

Kim, Joon-tae ^{[7
]}

Wolfe, Stacey Q. ^{[8
]}

Rai, Ansaar ^{[9
]}

Starke, Robert M. ^{[10
]}

Psychogios, Marios-Nikos ^{[11
]}

Samaniego, Edgar A. ^{[12
]}

Yoshimura, Shinichi ^{[3
]}

Cuellar, Hugo ^{[13
]}

Howard, Brian M. ^{[14
,15
]}

Alawieh, Ali ^{[14
]}

Alaraj, Ali ^{[16
]}

Ezzeldin, Mohamad ^{[17
,18
]}

Romano, Daniele G. ^{[19
]}

Tanweer, Omar ^{[20
]}

Mascitelli, Justin R. ^{[21
]}

Fragata, Isabel ^{[22
]}

Polifka, Adam J. ^{[23
]}

Siddiqui, Fazeel ^{[24
]}

Osbun, Joshua W. ^{[25
]}

Grandhi, Ramesh ^{[26
]}

Crosa, Roberto Javier ^{[27
]}

Matouk, Charles ^{[28
]}

Park, Min S. ^{[29
]}

Brinjikji, Waleed ^{[30
]}

Moss, Mark ^{[31
]}

Daglioglu, Ergun ^{[32
]}

Williamson, Richard ^{[33
]}

Navia, Pedro ^{[34
]}

Kan, Peter ^{[35
]}

De Leacy, Reade Andrew ^{[36
]}

Chowdhry, Shakeel A. ^{[37
]}

Altschul, David ^{[38
]}

Spiotta, Alejandro M. ^{[1
]}

Levitt, Michael R. ^{[39
]}

Goyal, Nitin ^{[2
]}

机构：

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

[2] Univ Tennessee, Hlth Sci Ctr, Dept Neurosurg, Memphis, TN USA

[3] Hyogo Coll Med, Dept Neurosurg, Nishinomiya, Japan

[4] UCSF, Dept Neurosurg, Sch Med, San Francisco, CA USA

[5] Univ Med Goettingen, Dept Neurol, Gottingen, NS, Germany

[6] Thomas Jefferson Univ, Dept Neurol Surg, Philadelphia, PA USA

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

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

[9] West Virginia Univ Hosp, Dept Radiol, Morgantown, WV USA

[10] Univ Miami, Miller Sch Med, Dept Neurol Surg, Miami, FL USA

[11] Univ Hosp Basel, Dept Neuroradiol, Clin Radiol & Nucl Med, Basel, Switzerland

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

[13] LSUHSC, Dept Neurosurg, Shreveport, LA USA

[14] Emory Univ, Sch Med, Dept Neurosurg, Atlanta, GA USA

[15] Emory Univ, Sch Med, Dept Radiol & Imaging Sci, Atlanta, GA USA

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

[17] Univ Houston, Coll Med, Dept Clin Sci, Houston, TX USA

[18] HCA Houston, Dept Neuroendovasc Surg, Houston, TX USA

[19] Univ Hosp San Giovanni Dio & Ruggi Aragona, Dept Neurordiol, Salerno, Italy

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

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

[22] Ctr Hosp Univ Lisboa Cent, Dept Neuroradiol, Lisbon, Portugal

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

[24] Univ Michigan Hlth West, Dept Neurosci, Wyoming, WY USA

[25] Washington Univ, St Louis Sch Med, Dept Neurosurg, St Louis, MO USA

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

[27] Med Uruguaya, Dept Endovasc Neurosurg, Montevideo, Montevideo, Uruguay

[28] Yale Univ, Dept Neurosurg, New Haven, CT USA

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

[30] Mayo Clin Minnesota, Dept Radiol, Rochester, MN USA

[31] Washington Reg JB Hunt Transport Serv Neurosci Ins, Dept Neuroradiol, Fayetteville, AZ USA

[32] Ankara Bilkent City Hosp, Dept Neurosurg, Ankara, Turkiye

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

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

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

[36] Icahn Sch Med Mt Sinai, Dept Neurosurg, New York, NY USA

[37] NorthShore Univ HealthSyst, Dept Neurosurg, Evanston, IL USA

[38] Montefiore Med Ctr, Dept Neurosurg, Bronx, NY USA

[39] Univ Washington, Sch Med, Dept Neurol Surg, Seattle, WA USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2024年

关键词：

Stroke; Thrombolysis; Thrombectomy; ACUTE ISCHEMIC-STROKE;

D O I：

10.1136/jnis-2024-021975

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background 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.Methods 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.Results 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).Conclusion 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.

引用

页数：8

共 30 条

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