Objective:
We investigated whether intravenous thrombolysis (IVT) affected the outcomes
and complications of mechanical thrombectomy (MT), specifically focusing on thrombus
fragmentation.
Methods:
The patients who underwent MT for large artery occlusion (LAO) were classified into
two groups: MT with prior IVT (MT+IVT) group and MT without prior IVT (MT-IVT) group.
The clinical outcome, successful recanalization with other radiological outcomes, and complications
were compared, between two groups. Subgroup analysis was also performed for patients with
simultaneous application of stent retriever and aspiration.
Results:
There were no significant differences in clinical outcome and successful recanalization
rate, between both groups. However, the ratio of pre- to peri-procedural thrombus fragmentation
was significantly higher in the MT+IVT group (14.6% and 16.2%, respectively; P=0.004) compared
to the MT-IVT group (5.1% and 6.8%, respectively; P=0.008). The MT+IVT group required
more second stent retriever (16.2%), more stent passages (median value = 2), and more occurrence
of distal emboli (3.9%) than the MT-IVT group (7.9%, median value = 1, and 8.1%, respectively)
(P=0.004, 0.008 and 0.018, respectively). In subgroup analysis, the results were similar to those of
the entire patients.
Conclusion:
Thrombus fragmentation of IVT with t-PA before MT resulted in an increased need
for additional rescue therapies, and it could induce more distal emboli. The use of IVT prior to MT
does not affect the clinical outcome and successful recanalization, compared with MT without
prior IVT. Therefore, we need to reconsider the need for IVT before MT.
Stenting as a Rescue Treatment After Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion