Intravenous thrombolysis upon flow restoration improves outcome in endovascular thrombectomy

被引:8
作者
Weller, Johannes M. [1 ]
Dorn, Franziska [2 ]
Petzold, Gabor C. [1 ,3 ]
Bode, Felix J. [1 ]
机构
[1] Univ Hosp Bonn, Dept Neurol, Div Vasc Neurol, Bonn, Germany
[2] Univ Hosp Bonn, Dept Neuroradiol, Bonn, Germany
[3] German Ctr Neurodegenerat Dis DZNE, Vasc Neurol Res Grp, Bonn, Nordrhein Westf, Germany
关键词
Stroke; Thrombectomy; Thrombolysis; ACUTE ISCHEMIC-STROKE;
D O I
10.1136/jnis-2022-019522
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background We hypothesized that ongoing IV thrombolysis (IVT) at flow restoration in patients with acute ischemic stroke (AIS) treated with IVT and endovascular thrombectomy (ET) is associated with improved outcome. Methods We included patients with IVT and successful recanalization (modified Thrombolysis in Cerebral Infarction score >= 2b) after ET from an observational multicenter cohort, the German Stroke Registry - Endovascular Treatment trial. Procedural characteristics and functional outcome at discharge and 90 days were compared between patients with and without ongoing IVT at flow restoration. To determine associations with functional outcome, adjusted ORs were calculated using ordinal multivariable logistic regression models adjusted for potential baseline confounder variables. Results Among 1303 patients treated with IVT and ET who achieved successful recanalization, IVT was ongoing in 13.8% (n=180) at flow restoration. Ongoing IVT was associated with better functional outcome at discharge (adjusted OR 1.61; 95% CI 1.13 to 2.30) and at 90 days (adjusted OR 1.52; 95% CI 1.06 to 2.18). Conclusion These results provide preliminary evidence for a benefit of ongoing IVT at flow restoration in patients with AIS treated with ET.
引用
收藏
页码:E229 / E231
页数:3
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