First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis

Background In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. Purpose The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. Methods We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0–2), and excellent outcome (defined as mRS score 0–1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. Results Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3–62.9; vs 38.3%, 95% CI 28.6–48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7–49.2; vs 52.4%, 47.7–57.1; pint = 0.45) and excellent outcome (32.1%, 25.7–38.5; vs 34.1%, 21.2–46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. Conclusions Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.

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EXPRESS: Stent Retriever Alone vs. Aspiration and Stent-Retriever Combination in Large Vessel Occlusion Stroke: A Matched Analysis

International Journal of Stroke ◽

10.1177/17474930211019204 ◽

2021 ◽

pp. 174749302110192

Author(s):

Mahmoud H Mohammaden ◽

Diogo C. Haussen ◽

Leonardo Pisani ◽

Alhamza Al-Bayati ◽

Aaron Anderson ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Functional Independence ◽

Stent Retriever ◽

Sensitivity Analyses ◽

First Line ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter ◽

First Pass ◽

Combined Technique

Background Three randomized clinical trials have reported similar safety and efficacy for contact aspiration (CA) and Stent-retriever (SR) thrombectomy. Aim We aimed to determine whether the Combined Technique (SR+CA) was superior to SR alone as first-line thrombectomy strategy in a patient cohort where balloon-guide catheter was universally used. Methods A prospectively maintained mechanical thrombectomy database from January 2018-December 2019 was reviewed. Patients were included if they had anterior circulation proximal occlusion ischemic stroke (intracranial ICA or MCA-M1/M2 segments) and underwent SR alone thrombectomy or SR+CA as first-line therapy. The primary outcome was the first-pass effect (FPE) (mTICI2c-3). Secondary outcomes included modified FPE (mTICI2b-3), successful reperfusion (mTICI2b-3) prior to and after any rescue strategy, and 90-day functional independence (mRS â¤2). Safety outcomes included rate of parenchymal hematoma (PH) type-2 and 90-day mortality. Sensitivity analyses were performed after dividing the overall cohort according to first-line modality into two matched groups. Results A total of 420 patients were included in the analysis (mean age 64.4 years; median baseline NIHSS 16[11-21]). As compared to first-line SR alone, first-line SR+CA resulted in similar rates of FPE (53% vs. 51%,aOR 1.122, 95%CI[0.745-1.691],p=0.58), mFPE (63% vs. 60.4%,aOR1.250, 95%CI[0.782-2.00],p=0.35), final successful reperfusion (97.6% vs. 98%,p=0.75) and higher chances of successful reperfusion prior to any rescue strategy (81.8% vs. 72.5%,aOR 2.033, 95%CI[1.209-3.419],p=0.007). Functional outcome and safety measures were comparable between both groups. Likewise, the matched analysis (148 patient-pairs) demonstrated comparable results for all clinical and angiographic outcomes except for significantly higher rates of successful reperfusion prior to any rescue strategies with the first-line SR+CA treatment (81.8% vs. 73.6%,aOR 1.881, 95%CI[1.039-3.405],p=0.037). Conclusions Our findings reinforce the findings of ASTER-2 trial in that the first-line thrombectomy with a Combined Technique did not result in increased rates of first-pass reperfusion or better clinical outcomes. However, addition of contact aspiration after initial SR failure might be beneficial in achieving earlier reperfusion.

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Abstract TMP7: Blood Pressure Goal Post Mechanical Yhrombectomy for Anterior and Posterior Circulation Stroke: A Multicenter Registry Study

Stroke ◽

10.1161/str.51.suppl_1.tmp7 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ming Yang ◽

Xiaochuan Huo ◽

Ning Ma ◽

Feng Gao ◽

Dapeng Mo ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Outcomes ◽

Functional Independence ◽

Artery Occlusion ◽

Posterior Circulation ◽

Blood Pressure Goal ◽

Large Artery ◽

Registry Study ◽

Anterior Circulation ◽

Posterior Circulation Stroke

Background and Purpose: The effect of blood pressure (BP) within 24 hours post-mechanical thrombectomy (MT) accounts on clinical outcomes for patients with successful reperfusion. We aimed to investigate the relationship between BP during 24 hours post-MT with clinical outcomes individually for anterior circulation stroke (ACS) or posterior circulation stroke (PCS) patients Method: Patients with successful recanalization and a full record of systolic BP (SBP) and diastolic BP (DBP) every two hours within 24 hours post-MT were included from the ANGEL study, a multi-centric, prospective registry study of endovascular treatment owing to proximal large-artery occlusion from June 2015 to December 2017. We divided patients into three groups based on maximum SBP: <140 (intensive), 140-160 (moderate) and <180 mmHg (permissive). Clinical outcomes included functional independence (modified Rankin Scale score 0-2), mortality at 90 days follow up and intracerebral hemorrhage (ICH). Results: 355 eligible patients were enrolled in this study. There were 162, 124, and 69 patients in the intensive, moderate, and permissive group, respectively. A 10mmHg increase of maximum SBP during the first 24 hours post-MT was independently associated with a lower likelihood of functional independence (OR=0.84 [0.75-0.94], p=0.001) at 90 days after adjusting for potential confounders. As to ACS, intensive SBP management was associated with higher odds of 90-day functional independence (OR=0.38 [0.18-0.79], p=0.010), compared with permissive SBP group. As to PCS, moderate SBP management was associated with lower odds of 90-day mortality, either compared with permissive or intensive SBP group. Conclusion: Higher maximum SBP post-MT was independently associated with a higher risk of poor clinical outcomes. Intensive SBP control may be more reasonable for patients with ACS, while moderate SBP is more beneficial for PCS. Although more randomized trials are needed.

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Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without Intravenous Thrombolysis

Neurology ◽

10.1212/wnl.0000000000012327 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012327

Author(s):

Niaz Ahmed ◽

Michael Mazya ◽

Ana Paiva Nunes ◽

Tiago Moreira ◽

Jyrki P. Ollikainen ◽

...

Keyword(s):

Cerebral Artery ◽

Intravenous Thrombolysis ◽

Functional Independence ◽

Artery Occlusion ◽

Large Artery ◽

Anterior Circulation ◽

Stroke Disability ◽

Artery First ◽

Symptomatic Intracranial Hemorrhage ◽

Residual Confounding

Objective:To test the hypothesis that intravenous thrombolysis (IVT) treatment prior to endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the SITS-International Stroke Thrombectomy Register (SITS-ISTR).Methods:We identified centers recording ≥10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014-19. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS 0-2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS-MOST. We performed propensity score matched (PSM) and multivariable logistic regression analyses.Results:Of 6350 patients from 42 centers, 3944 (62.1%) received IVT. IVT+EVT treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure and pre-stroke disability. PSM analysis showed that IVT+EVT patients had a higher rate of functional independence than EVT alone patients (46.4% vs. 40.3%, p<0.001) and a lower rate of death at 3 months (20.3% vs. 23.3%, p=0.035). SICH rates (3.5% vs. 3.0%, p= 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM.Interpretation:Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS Thrombectomy Registry. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding and possible residual confounding by indication.Classification of Evidence:This study provides Class II evidence that IVT prior to EVT increases the probability of functional independence at 3 months compared to EVT alone.

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Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011861 ◽

2015 ◽

Vol 8 (8) ◽

pp. 778-782 ◽

Cited By ~ 18

Author(s):

Christoph Kabbasch ◽

Anastasios Mpotsaris ◽

De-Hua Chang ◽

Sonja Hiß ◽

Franziska Dorn ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Intravenous Thrombolysis ◽

Outcome Data ◽

Stent Retriever ◽

Large Artery ◽

Stroke Patients ◽

Anterior Circulation ◽

Reported Data

PurposeTo investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV.Materials and methodsCase files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days.Results76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b–3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%).ConclusionsNeurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.

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Cortical Venous Changes on Susceptibility-Weighted Imaging Predict the Cerebral Collateral Circulation as Confirmed by Digital Subtraction Angiography

Frontiers in Neurology ◽

10.3389/fneur.2021.691430 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yun-Hao Zhan ◽

Yang-Kun Chen ◽

Run-Xiong Li ◽

Gen-Pei Luo ◽

Zhi-Qiang Wu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Collateral Circulation ◽

Artery Occlusion ◽

Susceptibility Weighted Imaging ◽

Large Artery ◽

Digital Subtraction ◽

Stroke Patients ◽

Severe Stenosis ◽

Anterior Circulation

Objective: Asymmetrical cortical vein sign (ACVS) shown on susceptibility-weighted imaging (SWI) can reflect regional hypoperfusion. We investigated if ACVS could predict the cerebral collateral circulation (CC) as assessed by digital subtraction angiography (DSA) in acute ischemic stroke patients with ipsilateral severe stenosis/occlusion of the anterior circulation.Methods: Clinical data and imaging data of 62 acute ischemic stroke patients with ipsilateral severe stenosis or occlusion of the anterior circulation confirmed by DSA were collected retrospectively. Participants underwent magnetic resonance imaging, including an SWI sequence. ACVS was defined as more and/or larger venous signals in the cerebral cortex of one side of SWI than that in the contralateral side. ACVS was measured using the Alberta Stroke Program Early Computed Tomography score based on SWI. The grading of the cerebral CC was judged using DSA.Results: Of the 62 patients, 30 patients (48.4%) had moderate-to-severe ACVS. According to DSA assessment, 19 patients (30.6%) had a good CC (grade 3–4), and 43 (69.4%) patients had a poor-to-moderate CC (grade 0–2). Among the 30 patients with moderate-to-severe ACVS, only three (10%) patients had a good CC, and 27 (90%) patients had a poor-to-moderate CC; among the 32 patients with none or mild ACVS, 16 (50%) of them had a good CC, and the other 50% had a moderate-to-severe CC. We constructed two logistic regression models with ACVS grading and none or mild ACVS entered into the models, respectively, together with age and large-artery occlusion. In model 1, no ACVS (compared with severe ACVS; OR = 40.329, 95%CI = 2.817–577.422, P = 0.006), mild ACVS (compared with severe ACVS; OR = 17.186, 1.735–170.224, 0.015) and large-artery occlusion (OR = 45.645, 4.603–452.592, 0.001) correlated with a good CC. In model 2, none or mild ACVS (OR = 36.848, 95%CI = 5.516–246.171, P < 0.001) was significantly associated with a good CC as judged by DSA, adjusted by age and large-artery occlusion.Conclusions: Cortical venous changes in SWI may be a useful indicator for the cerebral CC as confirmed by DSA.

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Prognosis of asymptomatic intracranial hemorrhage after endovascular treatment

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013848 ◽

2018 ◽

Vol 11 (2) ◽

pp. 123-126 ◽

Cited By ~ 5

Author(s):

Yonggang Hao ◽

Wenhua Liu ◽

Huaiming Wang ◽

Wenjie Zi ◽

Dong Yang ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Functional Outcomes ◽

Artery Occlusion ◽

Favorable Outcome ◽

Large Artery ◽

Anterior Circulation ◽

Excellent Outcome

ObjectiveAsymptomatic intracranial hemorrhage (aSICH) is a common phenomenon after endovascular treatment of acute ischemic stroke, but its prognostic impacts remain unclear. This study evaluated functional outcomes of thrombectomy in patients with and without aSICH.MethodsPatients with acute ischemic stroke due to large artery occlusion in the anterior circulation who were treated with thrombectomy were enrolled in 21 centers. According to CT scans performed within 72 hours of endovascular procedures, patients with aSICH or without intracranial hemorrhage were included while patients with symptomatic intracranial hemorrhage (SICH) were excluded. Baseline data and functional outcomes were compared between patients with aSICH and those without intracranial hemorrhage. Logistic regression analysis was applied to evaluate the impacts of aSICH on functional outcomes.ResultsOf the 632 patients with endovascular treatment, 101 (16.0%) were classified as having SICH, 212 (33.5%) as having aSICH, and 319 (50.5%) as being without intracranial hemorrhage. Patients with aSICH after endovascular treatment had a lower ratio of excellent outcome (mRS 0–1, OR 0.53; 95% CI 0.33 to 0.84, P=0.007) than those without intracranial hemorrhage. There were no significant differences concerning favorable outcome (mRS 0–2, OR 0.76; 95% CI 0.50 to 1.14, P=0.185) or mortality (OR 0.64; 95% CI 0.38 to 1.09, P=0.101) between patients with aSICH and those without intracranial hemorrhage.ConclusionsIn an Asian population, aSICH after thrombectomy may decrease the likelihood of an excellent functional outcome but does not influence a favorable outcome and mortality in patients with ischemic stroke due to large artery occlusion in the anterior circulation.

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Outcomes of endovascular treatment of basilar artery occlusion in the stent retriever era: a systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012089 ◽

2015 ◽

Vol 8 (11) ◽

pp. 1107-1115 ◽

Cited By ~ 35

Author(s):

Kevin Phan ◽

Steven Phan ◽

Ya Ruth Huo ◽

Fangzhi Jia ◽

Alex Mortimer

Keyword(s):

Systematic Review ◽

Endovascular Treatment ◽

Basilar Artery ◽

Meta Analysis ◽

Functional Independence ◽

Artery Occlusion ◽

Stent Retriever ◽

High Rate ◽

Basilar Artery Occlusion ◽

Anterior Circulation

BackgroundStent retriever thrombectomy has recently been found to be effective for anterior circulation strokes, but its efficacy for basilar artery occlusion (BAO) is unclear.ObjectiveTo carry out a systematic review and meta-analysis to analyze the available evidence for the use of stent retrievers for BAO.MethodsTwo independent reviewers searched six databases for studies reporting outcomes following endovascular treatment for BAO.ResultsA total of 17 articles (6 prospective and 11 retrospective) were included. The weighted mean age of patients was 67 years (range 59–82) and 59% were male. Thrombolytic drugs were administered intravenously and intra-arterially in 46% (range 0–88%) and 38% (range 0–90%) of patients, respectively. Weighted pooled estimates of successful recanalization (TICI 2b–3) and good outcome (modified Rankin Scale ≤2) were 80.0% (95% CI 70.7% to 88.0%; I2=80.28%; p<0.001) and 42.8% (95% CI 34.0% to 51.8%; I2=61.83%; p=0.002), respectively. Pooled mortality was 29.4% (95% CI 23.9% to 35.3%; I2=37.01%; p=0.087). Incidence of procedure-related complications and symptomatic hemorrhage was 10.0% (95% CI 3.7% to 18.3%; I2=61.05%; p=0.017) and 6.8% (95% CI 3.5% to 10.8%; I2=37.99%; p=0.08), respectively.ConclusionsStent retriever thrombectomy achieves a high rate of recanalization and functional independence while being relatively safe for patients with BAO. Future prospective studies with long-term follow-up are warranted.

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Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

10.21203/rs.3.rs-21802/v1 ◽

2020 ◽

Author(s):

Joonsang Yoo ◽

Seong-Joon Lee ◽

Jeong-Ho Hong ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Similar Efficacy ◽

Artery Occlusion ◽

Stent Retriever ◽

Large Artery ◽

First Line ◽

Vessel Occlusion ◽

Atherosclerotic Stenosis ◽

Significant Difference

Abstract Background: Although stent retriever (SR) is recommended as a frontline device of endovascular treatment (EVT) for embolic large artery occlusion causing acute ischemic stroke, contact aspiration (CA) device showed similar efficacy in the recent trials. However, the efficacy of the both devices as first-line therapy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion has not yet been established. Therefore, we compared the immediate effects and final outcomes of SR and CA as first-line devices for treating ICAS-related occlusions.Methods: We retrospectively analyzed the data of patients who underwent EVT for acute ischemic stroke from the registry of three Korean hospitals. Patients with ICAS-related occlusion who were treated within 24 hours of onset of the symptoms were included. We investigated immediate reperfusion performance, immediate safety outcomes, and 3-month clinical outcomes for the two first-line devices.Results: Of the 720 registered patients, 111 were eligible for this study. Forty-nine patients (44.1%) used SR and 62 (55.9%) used CA as the first-line device. Achieving successful reperfusion immediately after first-line thrombectomy was more frequent in the SR group than that in the CA group (77.6% vs. 43.5%, p = 0.001), with fewer additional rescue treatments (12.2% vs. 59.7%, p < 0.001). The incidence of iatrogenic dissection or rupture was lower in the SR group than that in the CA group (8.2% vs. 29.0%, p = 0.012). After additional rescue treatments, however, the final successful reperfusion rate did not differ between the two groups (SR 87.8% vs. CA 77.4%, p = 0.247), and there was no significant difference in the 3-month good outcomes (modified Rankin Scale, p = 0.524).Conclusions: First-line SR thrombectomy showed higher immediate reperfusion and less vessel injury for ICAS-related occlusions than CA. However, there was no significant difference in the final reperfusion status or 3-month outcomes from additional rescue treatments.

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Immediate Effects of First-line Thrombectomy Devices for Intracranial Atherosclerosis-Related Occlusion: Stent Retriever versus Contact Aspiration

10.21203/rs.3.rs-21802/v2 ◽

2020 ◽

Author(s):

Joonsang Yoo ◽

Seong-Joon Lee ◽

Jeong-Ho Hong ◽

Yong-Won Kim ◽

Ji Man Hong ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Similar Efficacy ◽

Artery Occlusion ◽

Stent Retriever ◽

Large Artery ◽

First Line ◽

Vessel Occlusion ◽

Atherosclerotic Stenosis ◽

Significant Difference

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Bridging Intravenous Thrombolysis Before Mechanical Thrombectomy for Large Artery Occlusion May be Detrimental with Thrombus Fragmentation

Current Neurovascular Research ◽

10.2174/1567202617666191223143831 ◽

2020 ◽

Vol 17 (1) ◽

pp. 18-26 ◽

Cited By ~ 3

Author(s):

Ho Jun Yi ◽

Jae Hoon Sung ◽

Dong Hoon Lee

Keyword(s):

Clinical Outcome ◽

Subgroup Analysis ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Stent Retriever ◽

Large Artery ◽

Simultaneous Application

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.

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