Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis.
Aged
Aged, 80 and over
Arterial Occlusive Diseases
/ complications
Cerebral Arteries
/ diagnostic imaging
Combined Modality Therapy
Female
Follow-Up Studies
Functional Status
Humans
Ischemic Stroke
/ drug therapy
Male
Middle Aged
Outcome Assessment, Health Care
Registries
/ statistics & numerical data
Thrombectomy
/ statistics & numerical data
Thrombolytic Therapy
/ statistics & numerical data
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
24 08 2021
24 08 2021
Historique:
received:
01
12
2020
accepted:
20
05
2021
pubmed:
6
6
2021
medline:
4
9
2021
entrez:
5
6
2021
Statut:
ppublish
Résumé
To test the hypothesis that IV thrombolysis (IVT) treatment before 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 Safe Implementation of Treatment in Stroke-International Stroke Thrombectomy Register (SITS-ISTR). 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 to 2019. 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 score 0-2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS-Monitoring Study. We performed propensity score-matched (PSM) and multivariable logistic regression analyses. Of 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT-treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT-treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%, Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication. This study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.
Identifiants
pubmed: 34088873
pii: WNL.0000000000012327
doi: 10.1212/WNL.0000000000012327
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e765-e776Informations de copyright
© 2021 American Academy of Neurology.