Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke
- 1 April 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 47 (4), 1037-1044
- https://doi.org/10.1161/strokeaha.115.011134
Abstract
Background and Purpose—: Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. Methods—: We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. Results—: From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia ( P =0.019), coronary heart disease ( P =0.039), and shorter intervals from symptom onset to endovascular intervention ( P =0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ ( P >0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage ( P =0.023) and lower mortality ( P =0.007) in the direct MT group. Conclusions—: In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.This publication has 26 references indexed in Scilit:
- Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in StrokeThe New England Journal of Medicine, 2015
- Thrombectomy within 8 Hours after Symptom Onset in Ischemic StrokeThe New England Journal of Medicine, 2015
- Stroke Neurologist’s Perspective on the New Endovascular TrialsStroke, 2015
- Randomized Assessment of Rapid Endovascular Treatment of Ischemic StrokeThe New England Journal of Medicine, 2015
- Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging SelectionThe New England Journal of Medicine, 2015
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Outcome of patients with occlusions of the internal carotid artery or the main stem of the middle cerebral artery with NIHSS score of less than 5: comparison between thrombolysed and non-thrombolysed patientsJournal of Neurology, Neurosurgery & Psychiatry, 2014
- The Importance of SizeStroke, 2011
- Tissue Plasminogen Activator for Acute Ischemic StrokeThe New England Journal of Medicine, 1995
- Measurements of acute cerebral infarction: a clinical examination scale.Stroke, 1989