Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct

Abstract

BackgroundThe safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone.MethodsThis is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups.ResultsA total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0–2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes.ConclusionPretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.

Effectiveness and safety of bridging therapy and endovascular therapy in patients with large cerebral infarctions: from ANGEL-ASPECT

“…Several other studies have reported similar results. 21 22 Anadani et al 22 conducted a research on patients with ASPECTS value ≤5 who underwent thrombectomy in the STAR trial. They used the propensity score matching method and found that the favourable outcomes (90-day mRS 0-2) and successful reperfusion rates were comparable between patients who underwent IVT and those who did not.…”

“…[18][19][20] Some studies evaluated the effect of endovascular treatments alone on the prognosis of patients with large cerebral infarctions, however, obtained conflicting results. [21][22][23][24] It has remained controversial whether endovascular therapy alone benefits patients with large cerebral infarctions. Our study was derived from the ANGEL-ASPECT to demonstrate whether endovascular therapy, combined with IVT, was safe and effective in the patients with large infarctions due to cerebral large-vessel occlusion.…”

Endovascular Therapy in Large Core Ischemic Strokes: Real-World Indian Experience

“…A retrospective study of 398 patients propensity matched in pairs under two groups of IVT before EVT versus EVT alone in patients with ASPECTS ≤5 did not show any significant difference in rates of any ICH or sICH between the two groups. [ 14 ]…”