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

Mohammad Anadani; Eyad Almallouhi; Ilko Maier; Sami Al Kasab; Pascal Jabbour; Joon Tae Kim; Stacey Q. Wolfe; Ansaar Rai; Robert M. Starke; Marios Nikos Psychogios; Edgar A. Samaniego; Adam S. Arthur; Shinichi Yoshimura; Hugo Cuellar; Brian M. Howard; Ali Alawieh; Isabel Fragata; Adam J. Polifka; Justin R. Mascitelli; Joshua W. Osbun; Charles Matouk; Min S. Park; Michael R. Levitt; Travis M. Dumont; Richard Williamson; Alejandro M. Spiotta

doi:10.1136/jnis-2022-019537

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

Mohammad Anadani, Eyad Almallouhi, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. Samaniego, Adam S. Arthur, Shinichi Yoshimura, Hugo Cuellar, Brian M. Howard, Ali Alawieh, Isabel Fragata, Adam J. Polifka, Justin R. Mascitelli, Joshua W. OsbunCharles Matouk, Min S. Park, Michael R. Levitt, Travis M. Dumont, Richard Williamson, Alejandro M. Spiotta

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Abstract

Background: The 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. Methods: This 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. Results: A 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. Conclusion: Pretreatment 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.

Original language	English
Article number	A838
Journal	Journal of NeuroInterventional Surgery
DOIs	https://doi.org/10.1136/jnis-2022-019537
State	Accepted/In press - 2023

Keywords

CT
Stroke
Thrombectomy
Thrombolysis

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10.1136/jnis-2022-019537

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Anadani, M., Almallouhi, E., Maier, I., Al Kasab, S., Jabbour, P., Kim, J. T., Wolfe, S. Q., Rai, A., Starke, R. M., Psychogios, M. N., Samaniego, E. A., Arthur, A. S., Yoshimura, S., Cuellar, H., Howard, B. M., Alawieh, A., Fragata, I., Polifka, A. J., Mascitelli, J. R., ... Spiotta, A. M. (Accepted/In press). Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct. Journal of NeuroInterventional Surgery, Article A838. https://doi.org/10.1136/jnis-2022-019537

@article{d6913a8c04d349e6a45bb1d9d7197cde,

title = "Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct",

abstract = "Background: The 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. Methods: This 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. Results: A 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. Conclusion: Pretreatment 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.",

keywords = "CT, Stroke, Thrombectomy, Thrombolysis",

author = "Mohammad Anadani and Eyad Almallouhi and Ilko Maier and {Al Kasab}, Sami and Pascal Jabbour and Kim, {Joon Tae} and Wolfe, {Stacey Q.} and Ansaar Rai and Starke, {Robert M.} and Psychogios, {Marios Nikos} and Samaniego, {Edgar A.} and Arthur, {Adam S.} and Shinichi Yoshimura and Hugo Cuellar and Howard, {Brian M.} and Ali Alawieh and Isabel Fragata and Polifka, {Adam J.} and Mascitelli, {Justin R.} and Osbun, {Joshua W.} and Charles Matouk and Park, {Min S.} and Levitt, {Michael R.} and Dumont, {Travis M.} and Richard Williamson and Spiotta, {Alejandro M.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/jnis-2022-019537",

language = "English",

journal = "Journal of NeuroInterventional Surgery",

issn = "1759-8478",

}

Anadani, M, Almallouhi, E, Maier, I, Al Kasab, S, Jabbour, P, Kim, JT, Wolfe, SQ, Rai, A, Starke, RM, Psychogios, MN, Samaniego, EA, Arthur, AS, Yoshimura, S, Cuellar, H, Howard, BM, Alawieh, A, Fragata, I, Polifka, AJ, Mascitelli, JR, Osbun, JW, Matouk, C, Park, MS, Levitt, MR, Dumont, TM, Williamson, R & Spiotta, AM 2023, 'Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct', Journal of NeuroInterventional Surgery. https://doi.org/10.1136/jnis-2022-019537

TY - JOUR

T1 - Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct

AU - Anadani, Mohammad

AU - Almallouhi, Eyad

AU - Maier, Ilko

AU - Al Kasab, Sami

AU - Jabbour, Pascal

AU - Kim, Joon Tae

AU - Wolfe, Stacey Q.

AU - Rai, Ansaar

AU - Starke, Robert M.

AU - Psychogios, Marios Nikos

AU - Samaniego, Edgar A.

AU - Arthur, Adam S.

AU - Yoshimura, Shinichi

AU - Cuellar, Hugo

AU - Howard, Brian M.

AU - Alawieh, Ali

AU - Fragata, Isabel

AU - Polifka, Adam J.

AU - Mascitelli, Justin R.

AU - Osbun, Joshua W.

AU - Matouk, Charles

AU - Park, Min S.

AU - Levitt, Michael R.

AU - Dumont, Travis M.

AU - Williamson, Richard

AU - Spiotta, Alejandro M.

PY - 2023

Y1 - 2023

N2 - Background: The 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. Methods: This 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. Results: A 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. Conclusion: Pretreatment 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.

AB - Background: The 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. Methods: This 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. Results: A 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. Conclusion: Pretreatment 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.

KW - CT

KW - Stroke

KW - Thrombectomy

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=85152704510&partnerID=8YFLogxK

U2 - 10.1136/jnis-2022-019537

DO - 10.1136/jnis-2022-019537

M3 - Article

C2 - 36990690

AN - SCOPUS:85152704510

SN - 1759-8478

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

M1 - A838

ER -

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

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Keywords

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