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BMC Neurology
Published in: BMC Neurology 1/2019

Open Access 01-12-2019 | Computed Tomography | Research article

Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results

Authors: Massimo Gamba, Nicola Gilberti, Enrico Premi, Angelo Costa, Michele Frigerio, Dikran Mardighian, Veronica Vergani, Raffaella Spezi, Ilenia Delrio, Andrea Morotti, Loris Poli, Valeria De Giuli, Filomena Caria, Alessandro Pezzini, Roberto Gasparotti, Alessandro Padovani, Mauro Magoni

Published in: BMC Neurology | Issue 1/2019

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Abstract

Background

endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients remains unclear. The present study aims to investigate whether IVT followed by ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS with LVO.

Methods

we achieved a single center retrospective study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. Functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up brain CT scan infarct volume (EFIV) (for recanalized patients only), symptomatic intracerebral hemorrhage (sICH) and 3-month mortality were the outcomes of interests. Independent predictors of the outcomes were explored with multivariable logistic regression.

Results

145 subjects were included in the study, of whom 70 underwent direct ET and 75 were treated with CoT. Functional independence at 3-months was more frequent in CoT subjects compared to patients who received direct ET (mRS score 0–1: 48.5% vs 18.6%; P < 0.001. mRS score 0–2: 67.1% vs 37.3%; P < 0.001); CoT patients had also higher first-pass success rate (62.7% vs 38.6%, P < 0.05), higher recanalization rate (84.3% vs 65.3%; P = 0.009) and, in recanalized subjects, smaller EFIV (16.4 ml vs 62.3 ml; P = 0.003). Mortality and intracranial bleeding did not differ between the two groups. In multivariable regression analysis, low baseline NIHSS score (P < 0.05), vessel recanalization (P = 0.05) and CoT (P = 0.03) were independent predictors of favorable outcome at three months.

Conclusions

CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.
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Metadata
Title
Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results
Authors
Massimo Gamba
Nicola Gilberti
Enrico Premi
Angelo Costa
Michele Frigerio
Dikran Mardighian
Veronica Vergani
Raffaella Spezi
Ilenia Delrio
Andrea Morotti
Loris Poli
Valeria De Giuli
Filomena Caria
Alessandro Pezzini
Roberto Gasparotti
Alessandro Padovani
Mauro Magoni
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2019
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-019-1341-3

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