Outcomes of endovascular thrombectomy with and without bridging thrombolysis for acute large vessel occlusion ischaemic stroke.

Abstract

Endovascular thrombectomy (EVT) for management of large vessel occlusion (LVO) acute ischaemic stroke (AIS) is now current best practice. The aim of this study was to determine if bridging intravenous alteplase therapy confers any clinical benefit. A retrospective study of patients treated with EVT for LVO was performed. Outcomes were compared between patients receiving thrombolysis and EVT with EVT alone. Primary endpoints were reperfusion rate, 90-day functional outcome and mortality using the modified Rankin scale (mRS) and symptomatic intracranial haemorrhage (sICH). A total of 355 patients who underwent EVT were included: 210 with thrombolysis (59%) and 145 without (41%). The reperfusion rate was higher in the group receiving IV tPA (unadjusted OR 2.2, 95% CI: 1.29-3.73, p=0.004) although this effect was attenuated when all variables were considered (adjusted OR [AOR] 1.22, 95% CI: 0.60-2.5, p=0.580). The percentage achieving functional independence (mRS 0-2) at 90-days was higher in patients who received bridging IV tPA (AOR 2.17, 95% CI:1.06-4.44, p=0.033). There was no significant difference in major complications including sICH (AOR 1.4, 95% CI: 0.51-3.83, p=0.512). There was lower 90-day mortality in the bridging IV tPA group (AOR 0.79, 95% CI: 0.36-1.74, p=0.551). Fewer thrombectomy passes (2 versus 3, p=0.012) were required to achieve successful reperfusion in the IV tPA group. Successful reperfusion (mTICI ≥2b) was the strongest predictor for 90-day functional independence (AOR 10.4, 95% CI:3.6-29.7, p<0.001). Our study supports the current practice of administering intravenous alteplase before endovascular therapy. This article is protected by copyright. All rights reserved.