Endovascular Thrombectomy with or without Intravenous Thrombolysis for Anterior Circulation Large Vessel Occlusion in the Imperial College London Thrombectomy Registry

Abstract

Background and purpose. Mechanical thrombectomy (MT) is the standard of care for eligible patients with a large vessel occlusion (LVO) acute ischemic stroke. Among patients undergoing MT there has been uncertainty regarding the role of intravenous thrombolysis (IVT) and previous trials have yielded conflicting results regarding clinical outcomes. We aim to investigate clinical, reperfusion outcomes and safety of MT with or without IVT for ischemic stroke due to anterior circulation LVO. Materials and Methods. This observational, prospective, single-centre study included consecutive patients with acute LVO ischemic stroke of the anterior circulation. The primary outcomes were the rate of in-hospital mortality, symptomatic intracranial haemorrhage and functional independence (mRS 0–2 at 90 days). Results. We enrolled a total of 577 consecutive patients: 161 (27.9%) were treated with MT alone while 416 (72.1%) underwent IVT and MT. Patients with MT who were treated with IVT had lower rates of in-hospital mortality (p = 0.037), higher TICI reperfusion grades (p = 0.007), similar rates of symptomatic intracranial haemorrhage (p = 0.317) and a higher percentage of functional independence mRS (0–2) at 90 days (p = 0.022). Bridging IVT with MT compared to MT alone was independently associated with a favorable post-intervention TICI score (>2b) (OR, 1.716; 95% CI, 1.076–2.735, p = 0.023). Conclusions. Our findings suggest that combined treatment with MT and IVT is safe and results in increased reperfusion rates as compared to MT alone.

Acute and Chronic Kidney Dysfunction and Prognosis following Thrombectomy for Ischemic Stroke

“…Intravenous thrombolysis, in addition to mechanical thrombectomy, was associated with better neurological outcome and lower mortality at 3 months. This is consistent with several recent large cohort studies [32‒34], which is debated as a recent meta-analysis concluded to a non-inferiority of thrombectomy alone compared to thrombectomy + thrombolysis [35].…”

Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

“…The Stroke Department at Charing Cross Hospital is the Northwest London (UK) regional Comprehensive Stroke Centre (CSC) for MT in an urban metropolitan area with more than 6.4 million people. Please refer to our previous manuscripts for the organization of the Imperial Stroke Thrombectomy network [ 22 , 23 ].…”

Safety and outcomes of different endovascular treatment techniques for anterior circulation ischaemic stroke in the elderly: data from the Imperial College Thrombectomy Registry

“…The Stroke Department at Charing Cross Hospital is the Northwest London (UK) regional Comprehensive Stroke Center (CSC) for MT in an urban metropolitan area with more than 6.4 million people. Please refer to our previous manuscripts for the organization of the Imperial Stroke Thrombectomy network [ 14 , 15 ]. In 2019, the life expectancy at birth in London was 85.4 years for women and 81.6 years for men [ 16 ].…”