O-037 Comparative safety and efficacy of combined intravenous thrombolysis and mechanical thrombectomy with mechanical thrombectomy alone in emergent large vessel occlusion

BackgroundFew data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO.MethodsConsecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0–2).ResultsThe study population included 217 patients with ELVO (mean age 62±14 years, 50% men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33%). Patients with APT pretreatment had higher SR rates (77% vs 61%; P=0.013). The two groups did not differ in terms of sICH (6% vs 7%), 3-month mortality (25% vs 26%), and 3-month functional independence (50% vs 48%). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95% CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95% CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95% CI 0.63 to 5.03; P=0.276).ConclusionAPT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.

Download Full-text

Author response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Neurology ◽

10.1212/wnl.0000000000006654 ◽

2018 ◽

Vol 91 (24) ◽

pp. 1116-1116

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Andrei V. Alexandrov ◽

Adam S. Arthur

Keyword(s):

Large Vessel ◽

Author Response ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comparative Safety

Download Full-text

Sonothrombolysis in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: An Individual Patient Data Meta-Analysis

Stroke ◽

10.1161/strokeaha.120.030960 ◽

2021 ◽

Author(s):

Georgios Tsivgoulis ◽

Aristeidis H. Katsanos ◽

Jürgen Eggers ◽

Vincent Larrue ◽

Lars Thomassen ◽

...

Keyword(s):

Clinical Trials ◽

Individual Patient Data ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Controlled Clinical Trials ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled

Background and Purpose: Evidence about the utility of ultrasound-enhanced thrombolysis (sonothrombolysis) in patients with acute ischemic stroke (AIS) is conflicting. We aimed to evaluate the safety and efficacy of sonothrombolysis in patients with AIS with large vessel occlusion, by analyzing individual patient data of available randomized-controlled clinical trials. Methods: We included all available randomized-controlled clinical trials comparing sonothrombolysis with or without addition of microspheres (treatment group) to intravenous thrombolysis alone (control group) in patients with AIS with large vessel occlusion. The primary outcome measure was the rate of complete recanalization at 1 to 36 hours following intravenous thrombolysis initiation. We present crude odds ratios (ORs) and ORs adjusted for the predefined variables of age, sex, baseline stroke severity, systolic blood pressure, and onset-to-treatment time. Results: We included 7 randomized controlled clinical trials that enrolled 1102 patients with AIS. A total of 138 and 134 confirmed large vessel occlusion patients were randomized to treatment and control groups respectively. Patients randomized to sonothrombolysis had increased odds of complete recanalization compared with patients receiving intravenous thrombolysis alone (40.3% versus 22.4%; OR, 2.17 [95% CI, 1.03–4.54]; adjusted OR, 2.33 [95% CI, 1.02–5.34]). The likelihood of symptomatic intracranial hemorrhage was not significantly different between the 2 groups (7.3% versus 3.7%; OR, 2.03 [95% CI, 0.68–6.11]; adjusted OR, 2.55 [95% CI, 0.76–8.52]). No differences in the likelihood of asymptomatic intracranial hemorrhage, 3-month favorable functional and 3-month functional independence were documented. Conclusions: Sonothrombolysis was associated with a nearly 2-fold increase in the odds of complete recanalization compared with intravenous thrombolysis alone in patients with AIS with large vessel occlusions. Further study of the safety and efficacy of sonothrombolysis is warranted.

Download Full-text

The Safety and Efficacy of Mechanical Thrombectomy in Posterior VS. Anterior Emergent Large Vessel Occlusion: A Systematic Review and Meta-analysis

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.104545 ◽

2020 ◽

Vol 29 (3) ◽

pp. 104545

Author(s):

Weisong Zhao ◽

Pengju Ma ◽

Weiming Zhao ◽

Biao Yang ◽

Yue Zhang ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Thrombectomy ◽

Meta Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Safety And Efficacy

Download Full-text

Abstract TP24: Impact of Pretreatment With Intravenous Thrombolysis on Reperfusion Status in Emergent Large Vessel Occlusion (ELVO) Patients Treated With Mechanical Thrombectomy (MT)

Stroke ◽

10.1161/str.50.suppl_1.tp24 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Abhi Pandhi ◽

Rashi Krishnan ◽

Konark Malhotra ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion

Download Full-text

Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19

Stroke ◽

10.1161/strokeaha.120.030574 ◽

2020 ◽

Vol 51 (8) ◽

pp. 2540-2543 ◽

Cited By ~ 33

Author(s):

Simon Escalard ◽

Benjamin Maïer ◽

Hocine Redjem ◽

François Delvoye ◽

Solène Hébert ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Stroke Onset ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Neurological Improvement ◽

Poor Outcomes

Background and Purpose: Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. Methods: All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. Results: We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. Conclusions: Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.

Download Full-text