scholarly journals Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites and risk factors

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091803
Author(s):  
DaoMing Tong ◽  
XiaoDong Chen ◽  
YuanWei Wang ◽  
Ying Wang ◽  
Li Du ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Insular Cortex ◽  
Large Vessel ◽  
Posterior Thalamus ◽  
Vessel Stenosis ◽  
Tertiary Teaching ◽  
Ischemic Events

Objective This study was performed to investigate the predilection sites of acute vestibular syndrome (AVS) and episodic vestibular syndrome (EVS) caused by acute infarcts. Methods This retrospective cohort study was performed at a stroke center in a tertiary teaching hospital. We diagnosed patients with AVS/EVS caused by acute ischemic stroke using diffusion-weighted imaging (DWI) and magnetic resonance angiography. Results Among all patients with AVS/EVS, 68 had DWI-positive ischemic events and 113 had DWI-negative ischemic events. Of the 68 patients with positive DWI findings, 42.6% had acute infarcts in the anterior circulation and 41.2% had acute infarcts in the posterior circulation. The main stroke predilection sites were the insular cortex (22.1%) and posterior thalamus (11.8%). Large vessel stenosis/occlusion (odds ratio, 0.12; 95% confidence interval, 0.04–0.36) and focal neurological symptoms/signs (odds ratio, 0.27; 95% confidence interval, 0.10–0.72) were significantly associated with the risk of AVS/EVS in patients with acute ischemic stroke. Conclusions The main predilection sites of AVS/EVS caused by ischemic stroke are the insular cortex and posterior thalamus. The risk of AVS/EVS is associated with large vessel stenosis and focal symptoms.

scholarly journals Acute and episodic vestibular syndromes caused by ischemic stroke: predilection sites on diffusion-weighted images

2019 ◽  
Author(s):  
Dao-Ming Tong ◽  
Xiao-Dong Chen ◽  
Ye-Ting Zhou ◽  
Tong-Hui Yang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Diffusion Weighted Images ◽  
Diffusion Weighted ◽  
Acute Vestibular Syndrome ◽  
Vessel Stenosis ◽  
Tertiary Teaching ◽  
Abcd2 Score

Abstract Background Although acute vestibular syndrome (AVS) and episodic vestibular syndrome (EVS) are an increasingly recognized cause of acute ischemic stroke, the predilection sites of AVS/EVS caused by acute ischemic stroke still is less known. Methods From Mar 2014 to Mar 2016 period, we used a new approach of 11thedition of the International Classification of Diseases (ICD-11) to retrospectively enrolled patients with identified AVS/EVS events caused by acute ischemic stroke in the stroke center of tertiary teaching hospital. The patients who had positive diffusion-weighted images (DWI) lesion and MRA were analyzed. Multivariable logistic regression was used to identify the risk of stroke causing AVS/EVS. Results Among 181 AVS/EVS patients with ischemic stroke, 68 (37.6%) patients with acute ischemic stroke were proved by DWI. Of them, the most frequent type was EVS (60.3%); the predilection sites of stroke was in the insular (51.7%, 15/29) in the anterior circulation artery (ACA), followed by the posterior of thalamus (28.6%, 8/28) in the posterior circulation artery (PCA). The lesion on DWI showed a median diameter of 4.0mm (range,0.6-89.4). The risk of AVS/EVS in acute ischemic stroke was found in association with large vessel stenosis/ occlusion (odds ratio[OR],, 0.12; 95% confidence interval [CI], 0.040-0.357), focal neurological symptom /sign (OR, 0.27; 95% CI, 0.104-0.751), and higher initial ABCD2 score (OR, 0.37; 95% CI, 0.239-0.573). Conclusions The predilection site of the AVS/EVS caused by acute ischemic stroke is in the insular. The risk of AVS/EVS was associated with a large vessel stenosis, focal neurological symptoms, and higher initial ABCD2 score.

Dual antiplatelet therapy pretreatment in IV thrombolysis for acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (11) ◽  
pp. e1067-e1076 ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Nitin Goyal ◽  
Ali Kerro ◽  
Aristeidis H. Katsanos ◽  
Rashi Krishnan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Propensity Score ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Dual Antiplatelet Therapy ◽  
Safety And Efficacy ◽  
Favorable Functional Outcome

ObjectiveWe sought to determine the safety and efficacy of IV thrombolysis (IVT) in acute ischemic stroke (AIS) patients with a history of dual antiplatelet therapy pretreatment (DAPP) in a prospective multicenter study.MethodsWe compared the following outcomes between DAPP+ and DAPP− IVT-treated patients before and after propensity score matching (PSM): symptomatic intracranial hemorrhage (sICH), asymptomatic intracranial hemorrhage, favorable functional outcome (modified Rankin Scale score 0–1), and 3-month mortality.ResultsAmong 790 IVT patients, 58 (7%) were on DAPP before stroke (mean age 68 ± 13 years; 57% men; median NIH Stroke Scale score 8). DAPP+ patients were older with more risk factors compared to DAPP− patients. The rates of sICH were similar between groups (3.4% vs 3.2%). In multivariable analyses adjusting for potential confounders, DAPP was associated with higher odds of asymptomatic intracranial hemorrhage (odds ratio = 3.53, 95% confidence interval: 1.47–8.47; p = 0.005) but also with a higher likelihood of 3-month favorable functional outcome (odds ratio = 2.41, 95% confidence interval: 1.06–5.46; p = 0.035). After propensity score matching, 41 DAPP+ patients were matched to 82 DAPP− patients. The 2 groups did not differ in any of the baseline characteristics or safety and efficacy outcomes.ConclusionsDAPP is not associated with higher rates of sICH and 3-month mortality following IVT. DAPP should not be used as a reason to withhold IVT in otherwise eligible AIS candidates.Classification of evidenceThis study provides Class III evidence that for IVT-treated patients with AIS, DAPP is not associated with a significantly higher risk of sICH. The study lacked the precision to exclude a potentially meaningful increase in sICH bleeding risk.

Prestroke Disability and Outcome After Thrombectomy for Emergent Anterior Circulation Large Vessel Occlusion Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012827
Author(s):  
Adam de Havenon ◽  
Alicia Castonguay ◽  
Raul Nogueira ◽  
Thanh N. Nguyen ◽  
Joey English ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion

ObjectiveTo determine the impact of endovascular therapy for large vessel occlusion stroke in patients with pre-morbid disability versus those without.MethodsWe performed a post-hoc analysis of the TREVO Stent-Retriever Acute Stroke (TRACK) Registry, which collected data on 634 consecutive stroke patients treated with the Trevo device as first-line EVT at 23 centers in the United States. We included patients with internal carotid or middle cerebral (M1/M2 segment) artery occlusions and the study exposure was patient- or caregiver-reported premorbid modified Rank Scale (mRS) ≥2 (premorbid disability, PD) versus premorbid mRS score 0-1 (no premorbid disability, NPD). The primary outcome was no accumulated disability, defined as no increase in 90-day mRS from the patient’s pre-morbid mRS.ResultsOf the 634 patients in TRACK, 407 patients were included in our cohort, of which 53/407 (13.0%) had PD. The primary outcome of no accumulated disability was achieved in 37.7% (20/53) of patients with PD and 16.7% (59/354) of patients with NPD (p<0.001), while death occurred in 39.6% (21/53) and 14.1% (50/354) (p<0.001), respectively. The adjusted odds ratio of no accumulated disability for PD patients was 5.2 (95% CI 2.4-11.4, p<0.001) compared to patients with NPD. However, the adjusted odds ratio for death in PD patients was 2.90 (95% CI 1.38-6.09, p=0.005).ConclusionsIn this study of anterior circulation acute ischemic stroke patients treated with EVT, we found that premorbid disability was associated with a higher probability of not accumulating further disability compared to patients with no premorbid disability, but also with higher probability of death.Classification of EvidenceThis study provides Class II evidence that in anterior circulation acute ischemic stroke treated with EVT, patients with premorbid disability compared to those without disability were more likely not to accumulate more disability but were more likely to die.


scholarly journals Predicting Clinical Outcomes After Thrombolysis Using the iScore

Stroke ◽  
2013 ◽  
Vol 44 (10) ◽  
pp. 2755-2759 ◽  
Author(s):  
Gustavo Saposnik ◽  
Mathew J. Reeves ◽  
S. Claiborne Johnston ◽  
Philip M.W. Bath ◽  
Bruce Ovbiagele
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Favorable Outcome ◽  
Tissue Type ◽  
Modified Rankin Scale ◽  
Secondary Outcomes

Background and Purpose— The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). Methods— We applied the iScore ( www.sorcan.ca/iscore ) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4–6), and Barthel index >90 at 3 months. Results— Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P <0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P =0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30–1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45–1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. Conclusions— The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.

scholarly journals FAST-ED scale smartphone app-based prediction of large vessel occlusion in suspected stroke by emergency medical service

2021 ◽  
Vol 14 ◽  
pp. 175628642110549
Author(s):  
Benedikt Frank ◽  
Thomas Lembeck ◽  
Nina Toppe ◽  
Bastian Brune ◽  
Bessime Bozkurt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Field Assessment

Background and Purpose: Considering the highly time-dependent therapeutic effect of endovascular treatment in patients with large vessel occlusion–associated acute ischemic stroke, prehospital identification of large vessel occlusion and subsequent triage for direct transport to a comprehensive stroke center offers an intriguing option for optimizing patient pathways. Methods: This prospective in-field validation study included 200 patients with suspected acute ischemic stroke who were admitted by emergency medical service to a comprehensive stroke center. Ambulances were equipped with smartphones running an app-based Field Assessment Stroke Triage for Emergency Destination scale for transmission prior to admission. The primary measure was the predictive accuracy of the transmitted Field Assessment Stroke Triage for Emergency Destination for large vessel occlusion and the secondary measure the predictive accuracy for endovascular treatment. Results: A Field Assessment Stroke Triage for Emergency Destination ⩾4 revealed very good accuracy to detect large vessel occlusion–related acute ischemic stroke with a sensitivity of 82.4% (95% confidence interval = 65.5–93.2), specificity of 78.3% (95% confidence interval = 71.3–84.3), and an area under the curve c-statistics of 0.89 (95% confidence interval = 0.85–0.94). Field Assessment Stroke Triage for Emergency Destination ⩾4 correctly identified 84% of patients who received endovascular treatment [73.5% specificity (95% confidence interval = 66.4–79.8)] with an area under the curve c-statistics of 0.82 (95% confidence interval = 0.74–0.89). In a hypothetical triage model of an urban setting, one secondary transportation would be avoided with every fifth patient screened. Conclusion: A smartphone app-based stroke triage completed by emergency medical service personnel showed adequate quality for the Field Assessment Stroke Triage for Emergency Destination to identify large vessel occlusion–associated acute ischemic stroke. We demonstrate feasibility of the use of a medical messaging service in prehospital stroke care. Based on these first results, a randomized trial evaluating the clinical benefit of such a triage system in an urban setting is currently in preparation. Clinical Trial Registration: https://clinicaltrials.gov Unique identifier: NCT04404504.

scholarly journals Body mass index is a risk factor for hemorrhagic transformation in older ischemic stroke patients after intravenous thrombolysis: a single center retrospective study

2019 ◽  
Author(s):  
Changqing Miao ◽  
Xiaoyan Yin ◽  
Chunying Mu ◽  
Yan Qu ◽  
Guogang Luo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Body Mass ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Tomography Scan

Abstract Background: The aim of our study was to determine whether body mass index is a predictor of hemorrhagic transformation in acute ischemic stroke patients after intravenous thrombolysis. Methods: A retrospective observational study was conducted to recruit 261 participants from a single center in China (67.0% males, median age 65 years). A head computed tomography scan was performed after 24 hours to evaluate hemorrhagic transformation occurrence, and a computed tomography scan was performed immediately in cases of clinical worsening. Multivariate logistic regression was used to estimate the association between risk factors and hemorrhagic transformation in acute ischemic stroke patients after intravenous administration of recombinant tissue plasminogen activator. Results: Of 261 patients, 40 (15.3%) developed hemorrhagic transformation (55% males, median age 70 years). Body mass index was higher in patients with hemorrhagic transformation than in patients without hemorrhagic transformation (25.7 vs 23.7; P value, 0.013). The multivariate logistic regression model showed that body mass index was an independent predictor of hemorrhagic transformation in patients aged ≥ 73 years (odds ratio, 1.74; 95% confidence interval, 1.22-2.49) but not in patients aged < 73 years (odds ratio, 1.01; 95% confidence interval, 0.87-1.18). In addition, the odds ratio was 5.16 (95% confidence interval, 2.21-12.04) when the body mass index was ≥ 25 kg/m2 compared to a body mass index < 25 kg/m2. Conclusions: The present study demonstrated that body mass index was an independent predictor of hemorrhagic transformation in older acute ischemic stroke patients after intravenous thrombolysis. Keywords: Body mass index, Hemorrhagic transformation, Intravenous thrombolysis, Ischemic stroke, Older patients.

scholarly journals Views of Emergency Physicians on Thrombolysis for Acute Ischemic Stroke

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2231 ◽  
Author(s):  
Bentley J. Bobrow ◽  
Bart M. Demaerschalk ◽  
Joseph P. Wood ◽  
Albert Villarin ◽  
Lani Clark ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Internet Survey ◽  
Emergency Physicians ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Attitudes And Knowledge ◽  
Risk Of Hemorrhage

Background The 3-hour window for treating stroke with intravenous tissue plasminogen activator (t-PA) requires well-organized, integrated efforts by emergency physicians and stroke neurologists. Objective To evaluate attitudes and knowledge of emergency physicians about intravenous t-PA for acute ischemic stroke, particularly in primary stroke centers (PSCs) with stroke neurology teams. Methods A 15-question pilot Internet survey administered by the Arizona College of Emergency Physicians. Results Between March and August 2005, 100 emergency physicians responded: 71 in Arizona and 29 in Missouri. Forty-eight percent practiced at PSCs; 48% thought t-PA was effective, 20% did not, and 32% were uncertain. PSC or non-PSC location of practice did not influence endorsement (odds ratio, 0.96; 95% confidence interval, 0.27–1.64). Of those opposing t-PA, 87% cited risk of hemorrhage. Conclusions Most emergency physicians did not endorse t-PA. Improved collaboration between emergency physicians and stroke neurologists is needed.

Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (21) ◽  
pp. e1971-e1978 ◽  
Author(s):  
Jinjing Wang ◽  
Fengli Li ◽  
Lulu Xiao ◽  
Feng Peng ◽  
Wen Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Odds Ratio ◽  
Serum Levels ◽  
Severity Scale ◽  
Index Stroke ◽  
Fatigue Severity

ObjectiveTo investigate whether thyroid function profiles can predict poststroke fatigue (PSF) in patients with acute ischemic stroke.MethodsPatients with stroke were consecutively recruited within 3 days of onset in Jinling Hospital. Serum levels of thyroid hormones, thyroid antibodies, hematologic indexes, and biochemical indexes were measured on admission. Fatigue was scored using the Fatigue Severity Scale. Associations were analyzed with multivariate regression and restricted cubic splines.ResultsOf the 704 patients with stroke, 292 (41.5%) were diagnosed with fatigue in the acute stage and 224 (35.3%) 6 months after the index stroke. The serum levels of thyroid-stimulating hormone (TSH) were inversely associated with the risk of PSF in both the acute phase and at follow-up evaluations after adjusting for potential confounders (odds ratio 0.30, 95% confidence interval 0.24–0.37 in the acute phase, and odds ratio 0.70, 95% confidence interval 0.58–0.84 at follow-up). The subgroup analysis indicated that in the acute phase of ischemic stroke, TSH was associated with severity of PSF in the groups with euthyroidism (β = −0.70, p < 0.001), subclinical hypothyroidism (β = −0.44, p < 0.001), and low-T3 syndrome (β = −0.34, p = 0.008). Higher TSH was associated with better Fatigue Severity Scale scores in patients with low-T3 syndrome 6 months after the index stroke (β = −0.35, p = 0.01). Furthermore, in the group with low-T3 syndrome, FT3 serum level could also indicate a higher risk of PSF (β = −2.54, p < 0.001 in the acute phase, and β = −2.67, p < 0.001 at follow-up).ConclusionThyroid function profiles may predict fatigue after acute ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.

Abstract WMP5: Endovascular Therapy Stroke Outcome in Very Elderly: Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
David S Liebeskind ◽  
Steven Cen ◽  
William J Mack ◽  
Arun P Amar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Odds Ratio ◽  
Age Groups ◽  
Large Vessel ◽  
Very Elderly

Introduction: Very elderly (age ≥80yo) individuals account for about one-third of all stroke admissions with mixed literature demonstrating relative poor stroke outcomes. With overwhelming recent evidence supporting the use of intra-arterial thrombectomy in addition to IV thrombolysis for large-vessel occlusive stroke, we conducted a metaanalysis to assess long-term functional outcome following mechanical thrombectomy in very elderly. Hypothesis: Very elderly patients with acute ischemic stroke treated with thrombectomy have equally favorable long-term functional outcomes to their younger counterparts Methods: Stroke endovascular trials published in New England Journal of Medicine 2014-2015 were included if they reported odds ratio of good functional outcome (improvement in modified Rankin score, mRS) comparing thrombectomy vs IV-tPA dichotomized by age groups (age ≤ 80yo vs >80yo, 2 studies dichotomized age at 70yo). Multivariate adjusted odds ratios and the corresponding standard errors were used for the metaanalysis. Pooled odds ratio estimates across trials were synthesized by using a random-effects model based on Mantel-Haenszel methods. The pooled estimates with 95% confidence interval were compared between elderly and younger age groups. Forest plots constructed. Results: Of the 5 recent intraartrial thrombectomy trials, 4 studies reported subgroup analysis by age with 1,206 participants, 28% (N=334) were above the age of 80yo, 72% (N=872) were ≤80yo. Among very elderly patients undergoing thrombectomy, the pooled odds ratio of good functional outcome at 3 months was 1.91 (1.13-3.24), in the younger group the pooled odds ratio was 1.95 (1.50-2.53). Conclusions: Endovascular therapy was an effective therapy for very elderly individuals presenting with acute ischemic stroke caused by large vessel occlusive disease. Future studies are needed to further assess the safety and effectiveness of thrombectomy in this growing population.

Abstract WMP4: Thrombectomy-only versus Combined Intravenous Alteplase and Thrombectomy: Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
Geoffrey P Colby ◽  
Rafael H Llinas
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Intravenous Alteplase ◽  
Iv Tpa

Introduction: Contraindications for intravenous thrombolysis are not infrequent (eg. anticoagulation, recent surgery, unclear last known well). With overwhelming recent evidence supporting the use of endovascular thrombectomy for large-vessel occlusive stroke, we conducted a metaanalysis to compare long-term functional outcome between thrombectomy-alone versus combined IV-tPA and thrombectomy. Hypothesis: Patients with acute ischemic stroke ineligible for IV-tPA treated with thrombectomy-alone have equally favorable long-term functional outcomes to patients treated with combined IV-tPA and thrombectomy Methods: Searched PubMed from 2014-2016 using pre-specified terms for studies that report odds ratio of improvement in mRS score at 90 days comparing thrombectomy vs IV-tPA stratified by whether patients had received IV-tPA. Multivariate adjusted odds ratios were used for the metaanalysis. Pooled odds ratio estimates across trials were synthesized by using a random-effects model based on Mantel-Haenszel methods. The pooled estimates were compared between thrombectomy-alone and combined IV-tPA and thrombectomy. Forest plots constructed. Results: Of the 920 studies, 3 studies reported subgroup analysis with 822 participants, 19.5% (N=160) received thrombectomy-alone, 80.5% (N=662) received combined IV-tPA and thrombectomy. Among patients who received thrombectomy-alone, the pooled odds ratio of good functional outcome at 3 months was 2.48 (1.43-4.30), in the combined IV-tPA and thrombectomy group the pooled odds ratio was 1.85 (1.37-2.49). Conclusions: Endovascular therapy was an effective therapy for patients ineligible for IV-tPA presenting with acute ischemic stroke caused by large vessel occlusive disease. While IV-tPA should not be withheld before thrombectomy in IV-tPA eligible patients, prospective studies are needed to select those who may benefit more from thrombectomy-only treatment.

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