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Updated: Aug 5, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effect of intravenous thrombolysis before endovascular therapy on outcomes in patients with large core infarct
Mohammad Anadani1, Eyad Almallouhi2, Ilko Maier3
1Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA spiotta@musc.edu anadani@musc.edu.
Insights
Bridging therapy with intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) did not increase hemorrhage risk in large core infarct patients. This study found similar safety and efficacy outcomes for IVT+MT versus MT alone.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Large core infarcts present unique challenges for stroke treatment.
- The role of bridging therapy (intravenous thrombolysis + mechanical thrombectomy) in these cases remains under-investigated.
Purpose of the Study:
- To compare the safety and efficacy of bridging therapy (IVT+MT) versus mechanical thrombectomy (MT) alone in patients with large core infarcts.
Main Methods:
- Retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR).
- Included patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT.
- Used propensity score matching to compare outcomes between IVT+MT and MT alone groups.
Main Results:
- No significant difference in any intracerebral hemorrhage (ICH) rates between groups (38.55% vs 42.1% in matched cohort).
- Similar rates of significant ICH and favorable outcomes (90-day mRS 0-2) were observed.
- Bridging IVT was not associated with increased hemorrhage risk or improved outcomes in adjusted analyses.
Conclusions:
- Pretreatment IVT is not associated with increased hemorrhage risk in large core infarct patients undergoing MT.
- Further research is required to fully establish the safety and efficacy of bridging therapy in this patient population.
Background:
The safety and efficacy of bridging therapy with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in patients with large core infarct has not been sufficiently studied. In this study, we compared the efficacy and safety outcomes between patients who received IVT+MT and those treated with MT alone.
Methods:
This is a retrospective analysis of the Stroke Thrombectomy Aneurysm Registry (STAR). Patients with Alberta Stroke Program Early CT Score (ASPECTS) ≤5 treated with MT were included in this study. Patients were divided into two groups based on pre-treatment IVT (IVT, no IVT). Propensity score matched analysis were used to compare outcomes between groups.
Results:
A total of 398 patients were included; 113 pairs were generated using propensity score matching analyses. Baseline characteristics were well balanced in the matched cohort. The rate of any intracerebral hemorrhage (ICH) was similar between groups in both the full cohort (41.4% vs 42.3%, P=0.85) and matched cohort (38.55% vs 42.1%, P=0.593). Similarly, the rate of significant ICH was similar between the groups (full cohort: 13.1% vs 16.9%, P=0.306; matched cohort: 15.6% vs 18.95, P=0.52). There was no difference in favorable outcome (90-day modified Rankin Scale 0-2) or successful reperfusion between groups. In an adjusted analysis, IVT was not associated with any of the outcomes.
Conclusion:
Pretreatment IVT was not associated with an increased risk of hemorrhage in patients with large core infarct treated with MT. Future studies are needed to assess the safety and efficacy of bridging therapy in patients with large core infarct.
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