Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke

Maingard, Julian; Shvarts, Yasmin; Motyer, Ronan; Thijs, Vincent; Brennan, Paul; O’Hare, Alan; Looby, Seamus; Thornton, John; Hirsch, Joshua A; Barras, Christen; Chandra, Ronil V.; Brooks, Mark; Asadi, Hamed; Kok, Hong Kuan

doi:10.1111/imj.14069

Cited by 25 publications

(29 citation statements)

References 36 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, patients treated with combined therapy had significantly lower rates of death/severe disability as compared with patients undergoing only MT. These results are consistent with those reported from observational studies 9–13,35,36 and available meta-analyses. 26,27 A recent post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization) showed a lower 90-day mortality rate in the IVT+MT group than after MT alone, and a better functional outcome, recanalization rate, and reduced mortality in a subgroup of patients.…”

Section: Discussionsupporting

confidence: 93%

“…Observational retrospective analyses gave conflicting results: while some of them suggested a benefit of IVT pretreatment, [9][10][11][12][13] in terms of higher rate of recanalization, shorter duration of the endovascular procedure, lower number of passes of the thrombectomy device per patient, or better clinical outcome, others did not find significant differences between the two approaches. [14][15][16][17][18][19][20][21][22] A pooled analysis 23 of the STAR 24 and SWIFT 25 trials suggested that treatment with IVT before MT does not add any clinical benefit as compared to MT alone.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

Casetta

Pracucci

Saletti³

et al. 2019

International Journal of Stroke

View full text Add to dashboard Cite

Background Whether mechanical thrombectomy alone may achieve better or at least equal clinical outcome than mechanical thrombectomy combined with intravenous thrombolysis is a matter of debate. Methods From the Italian Registry of Endovascular Stroke Treatment, we extracted all cases treated with intravenous thrombolysis followed by mechanical thrombectomy or with primary mechanical thrombectomy for anterior circulation stroke due to proximal vessel occlusion. We included only patients who would have qualified for intravenous thrombolysis. We compared outcomes of the two groups by using multivariate regression analysis and propensity score method. Results We included 1148 patients, treated with combined intravenous thrombolysis and mechanical thrombectomy therapy (n = 635; 55.3%), or with mechanical thrombectomy alone (n = 513; 44.7%). Demographic and baseline clinical characteristics did not differ between the two groups, except for a shorter onset to groin puncture time (p < 0.05) in the mechanical thrombectomy group. A shift in the 90-day modified Rankin Scale distributions toward a better outcome was found in favor of the combined treatment (adjusted common odds ratio = 1.3; 95% confidence interval: 1.04–1.66). Multivariate analyses on binary outcome show that subjects who underwent combined treatment had higher probability to survive with modified Rankin Scale 0–3 (odds ratio = 1.42; 95% confidence interval: 1.04–1.95) and lower case fatality rate (odds ratio = 0.6; 95% confidence interval: 0.44–0.9). Hemorrhagic transformation did not differ between the two groups. Conclusion These data seem to indicate that combined intravenous thrombolysis and mechanical thrombectomy could be associated with lower probability of death or severe dependency after three months from stroke due to large vessel occlusion, supporting the current guidelines of treating eligible patients with intravenous thrombolysis before mechanical thrombectomy.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

Casetta

Pracucci

Saletti³

et al. 2019

International Journal of Stroke

View full text Add to dashboard Cite

show abstract

“…IVT is associated with improved recanalization rates. This can be explained by the pharmacologic mechanism: the clot is dissolved from the outer edge and can therefore be accessed by the mechanical device easier [22]. Another explanation could be, that small fragments of the initial thrombus are dissolved during the intervention and do not occlude distal branches.…”

Section: Discussionmentioning

confidence: 99%

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

Purpose Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. Methods Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment.Results One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success.The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. Conclusion In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases.In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.

show abstract

“…To the Editor: Stroke is a sudden attack of disturbance of cerebral blood circulation; its incidence is getting higher and higher, and it has become the second most common cause of death, the fourth leading cause of loss of productivity, and the main cause of disability of people all over the world, [ 1 , 2 ] which has caused very serious pressure and burden on the social economy and public health. Although intravenous thrombolysis (IVT) with alteplase has been recognized as the first scheme for acute ischemic stroke within 4.5 h of onset, [ 3 , 4 ] there are still many patients who do not benefit from it and it lead to serious complications. Nowadays, endovascular thrombectomy (EVT) for acute ischemic stroke has also become a part of the standard treatment for patients with acute ischemic stroke complicated with large-vessel occlusion.…”

mentioning

confidence: 99%

“…Many epidemiological studies have shown that patients have no significant benefit from bridging endovascular thrombectomy compared with direct EVT (dEVT), [ 4 ] while other studies have shown the opposite results. [ 3 ]…”

mentioning

confidence: 99%

Should ateplase be used before endovascular thrombectomy in patients with acute stroke?

Yuan

Zhou

et al. 2020

Chinese Medical Journal

View full text Add to dashboard Cite

Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke

Abstract: Our study supports the current practice of administering intravenous alteplase before endovascular therapy. This article is protected by copyright. All rights reserved.

Cited by 25 publications

References 36 publications

Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

Combined intravenous and endovascular treatment versus primary mechanical thrombectomy. The Italian Registry of Endovascular Treatment in Acute Stroke

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Should ateplase be used before endovascular thrombectomy in patients with acute stroke?

Contact Info

Product

Resources

About