TY - JOUR
T1 - Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion
AU - Dmytriw, Adam A.
AU - Ghozy, Sherief
AU - Salim, Hamza Adel
AU - Musmar, Basel
AU - Siegler, James E.
AU - Kobeissi, Hassan
AU - Shaikh, Hamza
AU - Khalife, Jane
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Nguyen, Thanh N.
AU - Heit, Jeremy J.
AU - Regenhardt, Robert W.
AU - Cancelliere, Nicole M.
AU - El Naamani, Kareem
AU - Amllay, Abdelaziz
AU - Meyer, Lukas
AU - Dusart, Anne
AU - Bellante, Flavio
AU - Forestier, Geraud
AU - Rouchaud, Aymeric
AU - Saleme, Suzana
AU - Mounayer, Charbel
AU - Fiehler, Jens
AU - Kuhn, Anna Luisa
AU - Puri, Ajit S.
AU - Dyzmann, Christian
AU - Kan, Peter T.
AU - Colasurdo, Marco
AU - Marnat, Gaultier
AU - Berge, Jerome
AU - Barreau, Xavier
AU - Sibon, Igor
AU - Nedelcu, Simona
AU - Henninger, Nils
AU - Marotta, Thomas R.
AU - Stapleton, Christopher J.
AU - Rabinov, James D.
AU - Ota, Takahiro
AU - Dofuku, Shogo
AU - Yeo, Leonard L. L.
AU - Tan, Benjamin Y. Q.
AU - Martinez-Gutierrez, Juan Carlos
AU - Salazar-Marioni, Sergio
AU - Sheth, Sunil
AU - Renieri, Leonardo
AU - Capirossi, Carolina
AU - Hecker, Constantin
AU - Killer-Oberpfalzer, Monika
AU - Griessenauer, Christoph J.
AU - MAD-MT Consortium
N1 - Departments of Neurology & Neuro-surgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria(C.H., M.K.O., C.J.G.);
PY - 2024/8
Y1 - 2024/8
N2 - Background: The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion.Purpose: To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion.Materials and Methods: This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes.Results: After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, P <.001) and onset to recanalization (397 vs 273 minutes, P <.001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; P =.019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; P =.054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; P =.17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; P =.055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; P =.16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; P =.29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; P =.21).Conclusion: Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. (c) RSNA, 2024
AB - Background: The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion.Purpose: To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion.Materials and Methods: This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes.Results: After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, P <.001) and onset to recanalization (397 vs 273 minutes, P <.001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; P =.019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; P =.054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; P =.17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; P =.055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; P =.16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; P =.29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; P =.21).Conclusion: Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. (c) RSNA, 2024
KW - Mechanical thrombectomy
KW - Endovascular thrombectomy
KW - Intravenous thrombolysis
KW - Efficacy
KW - Safety
KW - Metaanalysis
KW - Alteplase
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=pmu_pure&SrcAuth=WosAPI&KeyUT=WOS:001381328100001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1148/radiol.233041
DO - 10.1148/radiol.233041
M3 - Original Article
C2 - 39105645
SN - 0033-8419
VL - 312
JO - RADIOLOGY
JF - RADIOLOGY
IS - 2
M1 - e233041
ER -