Early recanalization with intravenous thrombolysis before mechanical thrombectomy: considerations to explore with tenecteplase

Hendrix, Philipp; Schirmer, Clemens M.

doi:10.1136/jnis-2022-019981

Cited by 1 publication

(1 citation statement)

References 22 publications

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“…Current treatment options for acute ischemic stroke (AIS) patients with large vessel occlusions (LVOs) are intravenous thrombolysis (IVT) and endovascular treatment (EVT) [1,2]. IVT can induce rapid recanalization prior to EVT, may increase the rate of successful reperfusion with EVT, and can dissolve thrombi located in regions not reachable by EVT [2][3][4]. However, the administration of IVT before EVT increases the risk of hemorrhages and potentially increases the chances of thrombus fragmentation [5,6].…”

Section: Introductionmentioning

confidence: 99%

Thrombus Imaging Characteristics to Predict Early Recanalization in Anterior Circulation Large Vessel Occlusion Stroke

Arrarte Terreros,

Stolp,

Bruggeman

et al. 2024

JCDD

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The early management of transferred patients with a large vessel occlusion (LVO) stroke could be improved by identifying patients who are likely to recanalize early. We aim to predict early recanalization based on patient clinical and thrombus imaging characteristics. We included 81 transferred anterior-circulation LVO patients with an early recanalization, defined as the resolution of the LVO or the migration to a distal location not reachable with endovascular treatment upon repeated radiological imaging. We compared their clinical and imaging characteristics with all (322) transferred patients with a persistent LVO in the MR CLEAN Registry. We measured distance from carotid terminus to thrombus (DT), thrombus length, density, and perviousness on baseline CT images. We built logistic regression models to predict early recanalization. We validated the predictive ability by computing the median area-under-the-curve (AUC) of the receiver operating characteristics curve for 100 5-fold cross-validations. The administration of intravenous thrombolysis (IVT), longer transfer times, more distal occlusions, and shorter, pervious, less dense thrombi were characteristic of early recanalization. After backward elimination, IVT administration, DT and thrombus density remained in the multivariable model, with an AUC of 0.77 (IQR 0.72–0.83). Baseline thrombus imaging characteristics are valuable in predicting early recanalization and can potentially be used to optimize repeated imaging workflow.

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