Bridging Therapy with i. v. rtPA in MCA Occlusion Prior to Endovascular Thrombectomy: a Double-Edged Sword?

go back to reference Chen CJ, Ding D, Starke RM, Mehndiratta P, Crowley RW, Liu KC, Southerland AM, Worrall BB. Endovascular vs medical management of acute ischemic stroke. Neurology. 2015;85(22):1980–90. Chen CJ, Ding D, Starke RM, Mehndiratta P, Crowley RW, Liu KC, Southerland AM, Worrall BB. Endovascular vs medical management of acute ischemic stroke. Neurology. 2015;85(22):1980–90.

go back to reference Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.

go back to reference Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

go back to reference Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

go back to reference Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.

go back to reference Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372(24):2285–95. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.

go back to reference Chandra RV, Leslie-Mazwi TM, Mehta BP, Derdeyn CP, Demchuk AM, Menon BK, Goyal M, González RG, Hirsch JA. Does the use of IV tPA in the current era of rapid and predictable recanalization by mechanical embolectomy represent good value? J Neurointerv Surg. 2016;8(5):443–6. Chandra RV, Leslie-Mazwi TM, Mehta BP, Derdeyn CP, Demchuk AM, Menon BK, Goyal M, González RG, Hirsch JA. Does the use of IV tPA in the current era of rapid and predictable recanalization by mechanical embolectomy represent good value? J Neurointerv Surg. 2016;8(5):443–6.

go back to reference Leker RR, Pikis S, Gomori JM, Cohen JE. Is bridging necessary? A pilot study of bridging versus primary stentriever-based endovascular reperfusion in large anterior circulation strokes. J Stroke Cerebrovasc Dis. 2015;24(6):1163–7. Leker RR, Pikis S, Gomori JM, Cohen JE. Is bridging necessary? A pilot study of bridging versus primary stentriever-based endovascular reperfusion in large anterior circulation strokes. J Stroke Cerebrovasc Dis. 2015;24(6):1163–7.

go back to reference Behme D, Kabbasch C, Kowoll A, Dorn F, Liebig T, Weber W, Mpotsaris A. Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions. J Stroke Cerebrovasc Dis. 2016;25(4):954–9. Behme D, Kabbasch C, Kowoll A, Dorn F, Liebig T, Weber W, Mpotsaris A. Intravenous thrombolysis facilitates successful recanalization with stent-retriever mechanical thrombectomy in middle cerebral artery occlusions. J Stroke Cerebrovasc Dis. 2016;25(4):954–9.

go back to reference Guedin P, Larcher A, Decroix JP, Labreuche J, Dreyfus JF, Evrard S, Wang A, Graveleau P, Tassan P, Pico F, Coskun O, Rodesch G, Bourdain F, Lapergue B. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24(5):952–7. Guedin P, Larcher A, Decroix JP, Labreuche J, Dreyfus JF, Evrard S, Wang A, Graveleau P, Tassan P, Pico F, Coskun O, Rodesch G, Bourdain F, Lapergue B. Prior IV thrombolysis facilitates mechanical thrombectomy in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24(5):952–7.

go back to reference Pfefferkorn T, Holtmannspötter M, Patzig M, Brückmann H, Ottomeyer C, Opherk C, Dichgans M, Fesl G. Preceding intravenous thrombolysis facilitates endovascular mechanical recanalization in large intracranial artery occlusion. Int J Stroke. 2012;7(1):14–8. Pfefferkorn T, Holtmannspötter M, Patzig M, Brückmann H, Ottomeyer C, Opherk C, Dichgans M, Fesl G. Preceding intravenous thrombolysis facilitates endovascular mechanical recanalization in large intracranial artery occlusion. Int J Stroke. 2012;7(1):14–8.

go back to reference Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, Lapergue B, Amarenco P, Ajzenberg N, Jandrot-Perrus M, Michel JB, Ho-Tin-Noe B, Mazighi M. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke. 2015;46(11):3241–8. Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, Lapergue B, Amarenco P, Ajzenberg N, Jandrot-Perrus M, Michel JB, Ho-Tin-Noe B, Mazighi M. Alteplase reduces downstream microvascular thrombosis and improves the benefit of large artery recanalization in stroke. Stroke. 2015;46(11):3241–8.

go back to reference IST-3 collaborative group, Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, Innes K, Venables G, Czlonkowska A, Kobayashi A, Ricci S, Murray V, Berge E, Slot KB, Hankey GJ, Correia M, Peeters A, Matz K, Lyrer P, Gubitz G, Phillips SJ, Arauz A. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63. IST-3 collaborative group, Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, Innes K, Venables G, Czlonkowska A, Kobayashi A, Ricci S, Murray V, Berge E, Slot KB, Hankey GJ, Correia M, Peeters A, Matz K, Lyrer P, Gubitz G, Phillips SJ, Arauz A. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63.

go back to reference Takagi T, Yoshimura S, Uchida K, Enomoto Y, Egashira Y, Yamagami H, Sakai N; Committee of Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Study Group. Intravenous tissue plasminogen activator before endovascular treatment increases symptomatic intracranial hemorrhage in patients with occlusion of the middle cerebral artery second division: subanalysis of the RESCUE-Japan Registry. Neuroradiology. 2016;58(2):147–53. Takagi T, Yoshimura S, Uchida K, Enomoto Y, Egashira Y, Yamagami H, Sakai N; Committee of Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Study Group. Intravenous tissue plasminogen activator before endovascular treatment increases symptomatic intracranial hemorrhage in patients with occlusion of the middle cerebral artery second division: subanalysis of the RESCUE-Japan Registry. Neuroradiology. 2016;58(2):147–53.

go back to reference Weber R, Nordmeyer H, Hadisurya J, Heddier M, Stauder M, Stracke P, Berger K, Chapot R. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J Neurointerv Surg. 2016 Feb 22. pii: neurintsurg-2015-012236. doi:10.1136/neurintsurg-2015-012236. Weber R, Nordmeyer H, Hadisurya J, Heddier M, Stauder M, Stracke P, Berger K, Chapot R. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J Neurointerv Surg. 2016 Feb 22. pii: neurintsurg-2015-012236. doi:10.1136/neurintsurg-2015-012236.

go back to reference Broeg-Morvay A, Mordasini P, Bernasconi C, Bühlmann M, Pult F, Arnold M, Schroth G, Jung S, Mattle HP, Gralla J, Fischer U. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: A matched-pairs analysis. Stroke. 2016;47(4):1037–44. Broeg-Morvay A, Mordasini P, Bernasconi C, Bühlmann M, Pult F, Arnold M, Schroth G, Jung S, Mattle HP, Gralla J, Fischer U. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: A matched-pairs analysis. Stroke. 2016;47(4):1037–44.

go back to reference Kass-Hout T, Kass-Hout O, Mokin M, Thesier DM, Yashar P, Orion D, Jahshan S, Hopkins LN, Siddiqui AH, Snyder KV, Levy EI. Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke? World Neurosurg. 2014;82(3–4):453–8. Kass-Hout T, Kass-Hout O, Mokin M, Thesier DM, Yashar P, Orion D, Jahshan S, Hopkins LN, Siddiqui AH, Snyder KV, Levy EI. Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke? World Neurosurg. 2014;82(3–4):453–8.

go back to reference Saarinen JT, Sillanpää N, Rusanen H, Hakomäki J, Huhtala H, Lähteelä A, Dastidar P, Soimakallio S, Elovaara I. The mid-M1 segment of the middle cerebral artery is a cutoff clot location for good outcome in intravenous thrombolysis. Eur J Neurol. 2012;19(8):1121–7. Saarinen JT, Sillanpää N, Rusanen H, Hakomäki J, Huhtala H, Lähteelä A, Dastidar P, Soimakallio S, Elovaara I. The mid-M1 segment of the middle cerebral artery is a cutoff clot location for good outcome in intravenous thrombolysis. Eur J Neurol. 2012;19(8):1121–7.

go back to reference Porelli S, Leonardi M, Stafa A, Barbara C, Procaccianti G, Simonetti L. CT angiography in an acute stroke protocol: correlation between occlusion site and outcome of intravenous thrombolysis. Interv Neuroradiol. 2013;19(1):87–96.CrossRefPubMedPubMedCentral Porelli S, Leonardi M, Stafa A, Barbara C, Procaccianti G, Simonetti L. CT angiography in an acute stroke protocol: correlation between occlusion site and outcome of intravenous thrombolysis. Interv Neuroradiol. 2013;19(1):87–96.CrossRefPubMedPubMedCentral

go back to reference Friedrich B, Gawlitza M, Schob S, Hobohm C, Raviolo M, Hoffmann KT, Lobsien D. Distance to thrombus in acute middle cerebral artery occlusion: a predictor of outcome after intravenous thrombolysis for acute ischemic stroke. Stroke. 2015;46(3):692–6. Friedrich B, Gawlitza M, Schob S, Hobohm C, Raviolo M, Hoffmann KT, Lobsien D. Distance to thrombus in acute middle cerebral artery occlusion: a predictor of outcome after intravenous thrombolysis for acute ischemic stroke. Stroke. 2015;46(3):692–6.

go back to reference Linfante I, Llinas RH, Selim M, Chaves C, Kumar S, Parker RA, Caplan LR, Schlaug G. Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke. 2002;33(8):2066–71. Linfante I, Llinas RH, Selim M, Chaves C, Kumar S, Parker RA, Caplan LR, Schlaug G. Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke. 2002;33(8):2066–71.

go back to reference Kleine JF, Wunderlich S, Zimmer C, Kaesmacher J. Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy. J Neurointerv Surg. 2016 Feb 17. pii: neurintsurg-2015-012218. doi:10.1136/neurintsurg-2015-012218. Kleine JF, Wunderlich S, Zimmer C, Kaesmacher J. Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy. J Neurointerv Surg. 2016 Feb 17. pii: neurintsurg-2015-012218. doi:10.1136/neurintsurg-2015-012218.

go back to reference Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D; Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology; Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):109–37. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, Dillon W, Warach S, Broderick J, Tilley B, Sacks D; Technology Assessment Committee of the American Society of Interventional and Therapeutic Neuroradiology; Technology Assessment Committee of the Society of Interventional Radiology. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):109–37.

go back to reference Kleine JF, Beller E, Zimmer C, Kaesmacher J. Lenticulostriate infarctions after successful mechanical thrombectomy in middle cerebral artery occlusion. J Neurointerv Surg. 2016 Mar 3. pii: neurintsurg-2015-012243. doi:10.1136/neurintsurg-2015-012243. Kleine JF, Beller E, Zimmer C, Kaesmacher J. Lenticulostriate infarctions after successful mechanical thrombectomy in middle cerebral artery occlusion. J Neurointerv Surg. 2016 Mar 3. pii: neurintsurg-2015-012243. doi:10.1136/neurintsurg-2015-012243.

go back to reference Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L. Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3‑month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort. Stroke. 1999;30(11):2280–4.CrossRefPubMed Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L. Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3‑month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort. Stroke. 1999;30(11):2280–4.CrossRefPubMed

go back to reference Vach W. Regression models as a tool in medical research. Boca Raton: CRC Press; 2012. Vach W. Regression models as a tool in medical research. Boca Raton: CRC Press; 2012.

go back to reference Yan S, Chen Q, Xu M, Sun J, Liebeskind DS, Lou M. Thrombus length estimation on delayed gadolinium-enhanced T1. Stroke. 2016;47(3):756–61. Yan S, Chen Q, Xu M, Sun J, Liebeskind DS, Lou M. Thrombus length estimation on delayed gadolinium-enhanced T1. Stroke. 2016;47(3):756–61.

go back to reference Behrens L, Möhlenbruch M, Stampfl S, Ringleb PA, Hametner C, Kellert L, Pham M, Herweh C, Bendszus M, Rohde S. Effect of thrombus size on recanalization by bridging intravenous thrombolysis. Eur J Neurol. 2014;21(11):1406–10.PubMed Behrens L, Möhlenbruch M, Stampfl S, Ringleb PA, Hametner C, Kellert L, Pham M, Herweh C, Bendszus M, Rohde S. Effect of thrombus size on recanalization by bridging intravenous thrombolysis. Eur J Neurol. 2014;21(11):1406–10.PubMed

go back to reference Gratz PP, Schroth G, Gralla J, Mattle HP, Fischer U, Jung S, Mordasini P, Hsieh K, Verma RK, Weisstanner C, El-Koussy M. Whole-brain susceptibility-weighted thrombus imaging in stroke: fragmented thrombi predict worse outcome. AJNR Am J Neuroradiol. 2015;36(7):1277–82.CrossRefPubMed Gratz PP, Schroth G, Gralla J, Mattle HP, Fischer U, Jung S, Mordasini P, Hsieh K, Verma RK, Weisstanner C, El-Koussy M. Whole-brain susceptibility-weighted thrombus imaging in stroke: fragmented thrombi predict worse outcome. AJNR Am J Neuroradiol. 2015;36(7):1277–82.CrossRefPubMed

go back to reference Kleine JF, Boeckh-Behrens T, Prothmann S, Zimmer C, Liebig T. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg. 2016;8(7):671–6.CrossRefPubMed Kleine JF, Boeckh-Behrens T, Prothmann S, Zimmer C, Liebig T. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg. 2016;8(7):671–6.CrossRefPubMed