Abstract WP21: “Stunned Brain”– Early versus Delayed Clinical Recovery After Neurothrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shashvat Desai ◽  
Andrew A Morrison ◽  
Matthew Starr ◽  
Bradley J Molyneaux ◽  
Marcelo Rocha ◽  
...  
Keyword(s):  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Improvement ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Clinical Recovery ◽  
Procedural Information ◽  
Radiological Data ◽  
Younger Age ◽  
Patients Experience

Introduction: Heterogeneity in early neurological improvement after neurothrombectomy for large vessel occlusion (LVO) stroke is well documented. Delayed clinical recovery is observed in a subset of patients who do not experience early improvement. Understanding the temporality of clinical recovery after thrombectomy is essential in guiding prognostication and targeting rehabilitation. In this study, we aim to describe the characteristics and incidence of early and delayed clinical recovery and identify their predictors after LVO stroke thrombectomy. Methods: A retrospective analysis of prospectively-collected data on patients undergoing anterior circulation LVO stroke thrombectomy. Demographic characteristics, clinical and radiological data, treatment and procedural information were extracted and analyzed. Characteristics and predictors of early clinical recovery (ECR-1-NIHSS <6 at 24 hours and ECR-2-mRS 0-2 at discharge) and delayed clinical recovery (DCR-1 and 2- mRS 0-2 at 90 days) were analyzed. Statistical analyses were performed on SPSS 23 (IBM, Armonk, NY). Results: Three hundred and fifty-five patients met study criteria. 55% (195) were females and mean age was 71±15 years. Mean NIHSS score and median ASPECTS were 17±6 and 9 (8-10), respectively. ECR-1 and ECR-2 were observed in 31% (115) and 21% (73) patients, respectively. Among non-ECR patients, delayed recovery was observed in 27-30% of patients. Lower NIHSS [OR-0.83 (0.75-0.91), p=<0.01] and higher ASPECTS [OR-2.14, (1.29-3.54), p=0.003] scores were independent predictors of ECR-1 and younger age [OR-0.96 (0.94-0.99), p=0.01] and absence on parenchymal hemorrhage (PH) [OR-3.1 (1.3-7.1), p=0.007] were independent predictors of DCR-1. Among non-early improvers, patients <80 years and without PH have a 40% chance of DCR compared to no patients over 80 years with parenchymal hemorrhage experiencing DCR. Conclusion: About one-third of patients experience early clinical recovery (ECR-1-31%) and approximately one-third (DCR-1-30%) of non-early improvers experience delayed clinical recovery. Lower NIHSS score and higher ASPECTS predict ECR while younger age and absence of parenchymal hemorrhage predict DCR.

scholarly journals Delayed functional independence after thrombectomy: temporal characteristics and predictors

2020 ◽  
Vol 12 (9) ◽  
pp. 837-841
Author(s):  
Shashvat M Desai ◽  
Daniel A Tonetti ◽  
Andrew A Morrison ◽  
Bradley J Molyneaux ◽  
Matthew Starr ◽  
...  
Keyword(s):  
Infarct Volume ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Improvement ◽  
Nihss Score ◽  
Neurological Improvement ◽  
Procedural Information ◽  
Younger Age ◽  
Patients Experience

BackgroundVariability in early neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is well documented. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation.ObjectiveTo determine the incidence of early and delayed functional independence and identify associated predictors after EVT.MethodsA retrospective analysis of prospectively collected data on patients undergoing EVT in the setting of anterior circulation LVO was performed. Demographic, clinical, radiological, treatment, and procedural information were analyzed. Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0–2 at discharge) and delayed functional independence (DFI, mRS score 0–2 at 90 days in non-EFI patients) were analyzed.ResultsThree hundred and fifty-five patients met the study criteria. 55% were women and mean age was 71±15. Mean National Institutes of Health Stroke Scale (NIHSS) score was 17±6 and median Alberta Stroke Program Early CT Score was 9 (8-10). EFI was observed in 21% (73) of patients. Among non-EFI patients (282), DFI was observed in 30% (85) of patients. Shorter time to treatment (p=0.03), lower 24 hours NIHSS score (p<0.001), and smaller follow-up infarct volume (p=0.003) were independent predictors of EFI. Younger age (p=0.011), lower 24 hours NIHSS score (p=0.001), and absence of parenchymal hemorrhage (PH2; p=0.039) were independent predictors of DFI.ConclusionApproximately one-fifth of patients experience EFI and one-third of non-early improvers experience DFI. Younger age, lower 24 hours NIHSS score, and absence of parenchymal hemorrhage were independent predictors of DFI among non-early improvers. Further studies are required to improve our understanding of DFI.

Abstract 1122‐000176: Incidence and Predictors of Delayed Functional Independence in the TREVO Retriever Registry

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Shashvat M Desai ◽  
Ashutosh P Jadhav ◽  
Rishi Gupta ◽  
Blaise W Baxter ◽  
Bruno Bartolini ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Lower Blood Glucose ◽  
Early Improvement ◽  
Neurological Improvement ◽  
Procedural Information ◽  
Younger Age ◽  
Lower Blood

Introduction : Chronological heterogeneity in the neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is commonly observed in clinical practice. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation. We aim to determine the incidence of early and delayed functional independence and identify associated predictors after EVT. Methods : Demographic, clinical, radiological, treatment, and procedural information were analyzed from TREVO registry (patients undergoing EVT in the setting of anterior circulation LVO using the Trevo stent‐retriever). Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0–2 at discharge) and delayed functional independence (DFI, mRS score 0–2 at 90 days in non‐EFI patients) were analyzed. Results : A total of 1757 patients met study criteria. EFI was observed in 45% (785) of patients. Among non‐EFI patients (972), DFI was observed in 34% (332) of patients. Younger age (p<0.001), lower blood glucose (p<0.001), mTICI > = 2B (p = 0.01), and lower total number of thrombectomy passes (p = 0.004) were independent predictors of DFI. Conclusions : Approximately 45% of patients experience early functional independence. One‐third of non‐early improvers experience delayed functional independence. Younger age, lower blood glucose, better collateral grade, and lower total number of passes were independent predictors of DFI among non‐early improvers. Further studies are required to improve our understanding of DFI. No upload

Abstract TP2: Impact of Neglect on Outcomes After Right Hemisphere Stroke Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shashvat M Desai ◽  
Guru Ramaiah ◽  
Waqas Haq ◽  
Kunakorn Atchaneeyasakul ◽  
Matthew Starr ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Multivariate Analyses ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Younger Age ◽  
Severe Motor ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction: Right Hemisphere Strokes (RHS) are characterized by severe motor and sensory deficits and signs of neglect including extinction and inattention. National Institutes of Health Stroke Scale (NIHSS) score provides an objective measurement of presence or absence of neglect. Data regarding the impact of neglect on outcomes after RHS thrombectomy are lacking. We hypothesize that the presence of neglect in RHS is associated with worse outcomes after thrombectomy in RHS. Methods: Retrospective analysis of prospectively collected database of right sided anterior circulation large vessel occlusion [internal carotid and/or middle cerebral artery M1] strokes at a comprehensive stroke center. Patients with successful recanalization (TICI≥ 2B) and complete follow-up data were included in the study. Two group of RHS were identified- with and without neglect by itemized NIHSS. Baseline characteristics and outcomes were compared. Results: A total of 172 patients were included in the study. Median NIHSS score was 15 (11-18) and median ASPECTS was 9 (8-10). Signs of neglect were observed in 63% (108) of patients. In multivariate analyses, younger age [0.9 (0.8-0.95) p=<0.01] and higher ASPECTS [1.8 (1.1-3.1) p=0.015] were independent predictors of mRS 0-2 at 90 days. Absence of neglect [0.39 (0.13-1.1) p=0.07] may predict good outcome. Independent predictors of mortality on multivariate analyses included older age [1.1 (1.03-1.15) p =0.001], presence of atrial fibrillation [0.3 (0.1-1) p=0.05] and diabetes mellitus [0.16 (0.05-0.53) p=0.003]. Presence of neglect [2.5 (0.9-6.6) p=0.06] and lower ASPECTS [0.7 (0.4-1) p=0.06] may predict mortality. Conclusion: Signs of neglect were observed in approximately 63% of right hemisphere LVO strokes. Presence of neglect may predict poor functional outcome and mortality at 90 days after thrombectomy for right hemisphere strokes. Further studies are required to evaluate the impact of thrombectomy on recovery of neglect.

Abstract 118: Diffusion Lesion Volume Reduction after Recanalization Therapy for Anterior Circulation Stroke with Major Vessel Occlusion: Analysis from the RESCUE-Japan Registry Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Hiroshi Yamagami ◽  
Kazunori Toyoda ◽  
Yuji Matsumaru ◽  
Yukiko Enomoto ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Volume Reduction ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Median Baseline ◽  
Point Reduction ◽  
Major Vessel

Objective: Although Diffusion-weighted imaging (DWI) lesions are commonly irreversible, DWI lesion volume reduction (DVR) is occasionally observed. We investigated clinical significance and predictors of DVR in acute stroke patients with major vessel occlusion receiving recanalization therapy (RT). Methods: The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan registry prospectively registered 1,442 stroke patients with major vessel occlusion who were admitted to 84 Japanese stroke centers within 24 hours after onset from July 2010 to June 2011. We retrospectively analyzed all patients with the internal carotid artery or middle cerebral artery (M1 or M2 segments occlusions receiving RT and undergoing MRI both on admission and at 24 hours after onset from the registry. We defined DVR as a 1 or more-point reduction of the DWI-Alberta Stroke Program Early CT Score (ASPECTS), and CT-DWI mismatch (CTDM) as a 2 or more-point lower DWI-ASPECTS than CT-ASPECTS on admission. Reperfusion was defined as TICI grade 2b-3 on catheter angiography or modified Mori grade 3 on MRA immediately after RT. Dramatic recovery (DR) was defined as a 10 or more-point reduction or a total NIHSS score of 0-1 at 24 hours, and favorable outcome (FO) defined as a mRS score 0-2 at 3 months. Results: A total of 390 patients (215 men, 72 years old,) was included. Median baseline NIHSS score was 16 (IQR 10-19) and median baseline DWI-ASPECTS was 8 (6-9). CTDM was seen in 92 patients (28%) on admission. Intravenous thrombolysis and endovascular therapy were performed in 246 patients (63%) and 223 patients (57%), respectively. Reperfusion was obtained in 170 patients (51%). DVR was seen in 51 patients (13%). Eighty-eight patients (23%) obtained DR and 158 patients (41%) achieved FO. On multivariate analyses, DVR was significantly related to DR (OR 3.8, 95%CI 1.5-10) and FO (4.6, 1.8-12). CTDM was an independent predictor of DVR (OR 2.5, 95% CI 1.1-5.8). Conclusions: DVR was significantly related to DR and FO. CTDM is a rough predictor of DVR of which area is considered as a “DWI-bright” ischemic penumbra, and might be a useful marker to identify the adequate candidates for RT in spite of relatively large DWI lesions.

Prognostic importance of CT ASPECTS and CT perfusion measures of infarction in anterior emergent large vessel occlusions

2018 ◽  
Vol 11 (7) ◽  
pp. 670-674 ◽  
Author(s):  
Syed Ali Raza ◽  
Clara M Barreira ◽  
Gabriel M Rodrigues ◽  
Michael R Frankel ◽  
Diogo C Haussen ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Area Under The Curve ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Median Baseline ◽  
Ct Head ◽  
Prognostic Importance ◽  
Contrast Ct

BackgroundAge, neurologic deficits, core volume (CV), and clinical core or radiographic mismatch are considered in selection for endovascular therapy (ET) in anterior circulation emergent large vessel occlusion (aELVO). Semiquantitative CV estimation by Alberta Stroke Programme Early CT Score (CT ASPECTS) and quantitative CV estimation by CT perfusion (CTP) are both used in selection paradigms.ObjectiveTo compare the prognostic value of CTP CV with CT ASPECTS in aELVO.MethodsPatients in an institutional endovascular registry who had aELVO, pre-ET National Institutes of Health Stroke Scale (NIHSS) score, non-contrast CT head and CTP imaging, and prospectively collected 3-month modified Rankin Scale (mRS) score were included. Age- and NIHSS-adjusted models, including either CT ASPECTS or CTP volumes (relative cerebral blood flow <30% of normal tissue, total hypoperfusion, and radiographic mismatch), were compared using receiver operator characteristic analyses.ResultsWe included 508 patients with aELVO (60.8% M1 middle cerebral artery, 34% internal carotid artery, mean age 64.1±15.3 years, median baseline NIHSS score 16 (12–20), median baseline CT ASPECTS 8 (7–9), mean CV 16.7±24.8 mL). Age, pre-ET NIHSS, CT ASPECTS, CV, hypoperfusion, and perfusion imaging mismatch volumes were predictors of good outcome (mRS score 0–2). There were no differences in prognostic accuracies between reference (age, baseline NIHSS, CT ASPECTS; area under the curve (AUC)=0.76) and additional models incorporating combinations of age, NIHSS, and CTP metrics including CV, total hypoperfusion or mismatch volume (AUCs 0.72–0.75). Predicted outcomes from CT ASPECTS or CTP CV-based models had excellent agreement (R2=0.84, p<0.001).ConclusionsIncorporating CTP measures of core or penumbral volume, instead of CT ASPECTS, did not improve prognostication of 3-month outcomes, suggesting prognostic equivalence of CT ASPECTS and CTP CV.

scholarly journals Pretreatment predictors of malignant evolution in patients with ischemic stroke undergoing mechanical thrombectomy

2017 ◽  
Vol 10 (4) ◽  
pp. 340-344 ◽  
Author(s):  
Alessandro Davoli ◽  
Caterina Motta ◽  
Giacomo Koch ◽  
Marina Diomedi ◽  
Simone Napolitano ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Predictive Value ◽  
Multivariate Regression Analysis ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Middle Cerebral Artery Infarction ◽  
Intracranial Vessel ◽  
Radiological Data ◽  
Practical Model ◽  
Few Data

BackgroundFew data exist on malignant middle cerebral artery infarction (MMI) among patients with acute ischemic stroke (AIS) after endovascular treatment (ET). Numerous predictors of MMI evolution have been proposed, but a comprehensive research of patients undergoing ET has never been performed. Our purpose was to find a practical model to determine robust predictors of MMI in patients undergoing ET.MethodsPatients from a prospective single-center database with AIS secondary to large intracranial vessel occlusion of the anterior circulation, treated with ET, were retrospectively analyzed. We investigated demographic, clinical, and radiological data. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.Results98 patients were included in the analysis, 35 of whom developed MMI (35.7%). No differences in the rate of successful reperfusion and time from stroke onset to reperfusion were found between the MMI and non-MMI groups. The following parameters were identified as independent predictors of MMI: systolic blood pressure (SBP) on admission (p=0.008), blood glucose (BG) on admission (p=0.024), and the CTangiography (CTA) Alberta Stroke Program Early CT Score (ASPECTS) (p=0.001). A scoreof ≤5 in CTA ASPECTS was the best cut-off to predict MMI evolution (sensitivity 46%; specificity 97%; positive predictive value 78%; negative predictive value 65%).Conclusionsin our study a clinical and radiological features-based model was strongly predictive of MMI evolution in AIS. High SBP and BG on admission and, especially, a CTA ASPECTS ≤5 may help to make decisions quickly, regardless of time to treatment and successful reperfusion.

Catch Plus thrombectomy device in acute stroke: initial evaluation

2016 ◽  
Vol 9 (12) ◽  
pp. 1214-1218 ◽  
Author(s):  
Ahmet Peker ◽  
Ethem Murat Arsava ◽  
Mehmet Akif Topçuoğlu ◽  
Anıl Arat
Keyword(s):  
Mechanical Thrombectomy ◽  
National Institutes Of Health ◽  
Initial Experience ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Thrombectomy Device ◽  
Baseline Characteristics ◽  
Mean Time

ObjectiveTo report our initial experience with the Catch Plus thrombectomy device (CPD) in patients with acute ischemic stroke (AIS).Materials and methodsWe retrospectively evaluated the procedural variables as well as the clinical and angiographic outcomes of patients with acute occlusion of a major intracranial artery in the anterior circulation who were treated with CPD at our center. Baseline characteristics (gender, age, comorbidities, cardiovascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, and vessel occlusion sites) of these patients were recorded. Thrombolysis in Cerebral Infarction (TICI) score, incidence of symptomatic and asymptomatic bleeding, and 90 day modified Rankin Scale (mRS) scores were evaluated as indicators of outcome.Results38 patients with a mean age of 67.5 years were treated with CPD. Mean time from symptom onset to procedure initiation was 226.7 min. Recanalization (TICI 2b–3) was achieved in 27 patients (71.1%). The median NIHSS score on admission was 20. Rates of symptomatic and asymptomatic intracerebral hemorrhage were 7.9% and 13.2%, respectively. The 90 day clinical follow-up data were available for 37 patients. The 90 day mortality rate was 18.9%, and the 90 day clinically acceptable functional outcome (mRS score ≤2) rate was 43.2% (mRS score 0–3, 54.1%). Very distal thrombectomy involving the cortical arteries was performed on four patients without complications.ConclusionsOur initial experience suggests that mechanical thrombectomy with the CPD improves 90 day outcomes of patients with AIS by facilitating effective recanalization.

scholarly journals Lower Intraprocedural Systolic Blood Pressure Predicts Good Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

2015 ◽  
Vol 4 (3-4) ◽  
pp. 151-157 ◽  
Author(s):  
Seby John ◽  
Walaa Hazaa ◽  
Ken Uchino ◽  
Gabor Toth ◽  
Mark Bain ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Hemodynamic Variable ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Nihss Score ◽  
Good Outcome

Background: It is unknown if intraprocedural blood pressure (BP) influences clinical outcomes and what BP parameter best predicts outcomes in acute ischemic stroke (AIS) patients who undergo intra-arterial therapy (IAT) for emergent large vessel occlusion. Methods: We retrospectively reviewed 147 patients who underwent IAT for anterior circulation AIS from January 2008 to December 2012 at our institution. Baseline demographics, stroke treatment variables, and detailed intraprocedural hemodynamic variables were collected. Results: The entire cohort consisted of 81 (55%) females with a mean age of 66.9 ± 15.6 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 16 (IQR 11-21). Thirty-six (24.5%) patients died during hospitalization, 25 (17%) achieved a 30-day modified Rankin Scale score of 0-2, and 24 (16.3%) suffered symptomatic parenchymal hematoma type 1/2 hemorrhage. Patients who achieved a good outcome had a significantly lower admission NIHSS score, a higher baseline CT ASPECTS score, and a lower rate of ICA terminus occlusions. Successful recanalization was more frequent in the good-outcome group, while symptomatic hemorrhages occurred only in poor-outcome patients. The first systolic BP (SBP; 146.5 ± 0.2 vs. 157.7 ± 25.6 mm Hg, p = 0.042), first mean arterial pressure (MAP; 98.1 ± 20.8 vs. 109.7 ± 20.3 mm Hg, p = 0.024), maximum SBP (164.6 ± 27.6 vs. 180.9 ± 18.3 mm Hg, p = 0.0003), and maximum MAP (125.5 ± 18.6 vs. 138.5 ± 24.6 mm Hg, p = 0.0309) were all significantly lower in patients who achieved good outcomes. A lower maximum intraprocedural SBP was an independent predictor of good outcome (adjusted OR 0.929, 95% CI 0.886-0.963, p = 0.0005). Initial NIHSS score was the only other independent predictor of a good outcome. Conclusion: Lower intraprocedural SBP was associated with good outcome in patients undergoing IAT for AIS, and maximum SBP was an independent predictor of good outcome. SBP may be the optimal hemodynamic variable to monitor intraprocedurally during IAT and may predict outcome.

scholarly journals Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre

2017 ◽  
Vol 7 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Chee-Keong Wee ◽  
William McAuliffe ◽  
Constantine C. Phatouros ◽  
Timothy J. Phillips ◽  
David Blacker ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
Group Versus ◽  
Large Artery ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Neurological Improvement

Background and Purpose: Endovascular thrombectomy (EVT) improves the functional outcome when added to best medical therapy, including alteplase, in patients with acute ischaemic stroke secondary to large vessel occlusion (LVO) in the anterior circulation. However, the evidence for EVT in alteplase-ineligible patients is less compelling. It is also uncertain whether alteplase is necessary in patients with successful recanalization by EVT, as the treatment effect of EVT may be so powerful that bridging alteplase may not add to efficacy and may compromise safety by increasing bleeding risks. We aimed to survey the proportion of patients suitable for EVT who are alteplase-ineligible and to compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital clinical stroke service. Methods: We performed a retrospective analysis of acute ischaemic stroke patients treated with EVT at our centre between October 2013 and April 2016, based on a registry with prospective and consecutive patient collection. Individual patient records were retrieved for review. Significant early neurological improvement was defined as a NIHSS score of 0–1, or a decrease from baseline of ≤8, at 24 h after stroke onset. Results: Fifty patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, of whom 21 (42%) received concurrent alteplase and 29 (58%) EVT alone. The 2 groups had similar baseline characteristics and similar outcomes. Significant neurological improvement at 24 h occurred in 47.6% of the patients with EVT and bridging alteplase and in 51.7% of the patients with EVT alone (p = 0.774). Mortality during acute hospitalization was 20% for the bridging alteplase group versus 7.1% for EVT alone (p = 0.184). Intracranial haemorrhage rates were 14.3% for bridging alteplase versus 20.7% for EVT alone (p = 0.716). Local complications, groin haematoma (23.8 vs. 10.3%) and groin pseudoaneurysms (4.8 vs. 0%) (p = 0.170), were not significantly different. Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.

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