Mechanical Thrombectomy Outcomes With or Without Intravenous Thrombolysis

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• Intravenous thrombolysis (IVT) within 4.5 hours is standard before mechanical thrombectomy (MT) for stroke.
• Comparison of IVT preceding MT versus MT alone is crucial for optimizing treatment protocols.

Purpose of the Study:

• To compare functional outcomes, neurological recovery, reperfusion rates, and safety events between IVT followed by MT (IVT+MT) and MT alone.
• To identify specific patient subgroups that may benefit more from the IVT+MT approach.

Main Methods:

• Post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization).
• Inclusion of 381 patients, with 250 receiving IVT before MT.
• Primary outcome: favorable 90-day functional outcome (modified Rankin Scale ≤2). Secondary outcomes: reperfusion rates, National Institutes of Health Stroke Scale score changes, and safety events.

Main Results:

• No significant differences in 90-day functional outcome, reperfusion, or neurological improvement between IVT+MT and MT alone groups.
• The 90-day mortality rate was significantly lower in the IVT+MT group (risk ratio 0.59).
• In patients without prestroke anticoagulation, IVT+MT showed improved functional outcome (risk ratio 1.38), higher first-line recanalization (risk ratio 1.26), and lower mortality (risk ratio 0.58).

Conclusions:

• IVT followed by MT is associated with reduced 90-day mortality in acute ischemic stroke patients compared to MT alone.
• For patients not on anticoagulants, IVT+MT may enhance functional outcomes and recanalization rates while decreasing mortality.