Stent-Based Thrombectomy Versus Intravenous Tissue Plasminogen Activator in Patients With Acute Middle Cerebral Artery Occlusion

Abstract

Background and Purpose-Our goal was to compare outcomes of patients with proximal middle cerebral artery occlusions treated with intravenous tissue plasminogen activator (tPA) with those of patients treated with stent-based thrombectomy (SBT). Methods-Patients with proximal middle cerebral artery occlusions included in our prospective stroke registry were identified. Patients presenting with moderate to severe stroke defined as National Institutes of Health Stroke Scale score ≥10 were included. Patients treated with tPA were compared with those treated with SBT. Disability was measured with the modified Rankin Scale and shifts toward favorable outcomes (modified Rankin Scale ≤2) were analyzed. Logistic regression was used to determine outcome modifiers.

Safety and Efficacy of Mechanical Thrombectomy Using Stent Retrievers in the Endovascular Treatment of Acute Ischaemic Stroke: A Systematic Review

“…According to the inclusion and exclusion criteria, 17 primary studies were finally selected: 2 RCTs, 3 comparative studies (stent retrievers vs. rtPA, Merci ® or another stent) and 12 case series ( table 1 ). The Solitaire TM device was assessed alone in 10 studies (n = 1,267) [21][22][23][24][25][26][27][28][29][30] , Trevo ® in 4 (n = 221) [30][31][32][33] and Revive TM in 1 (n = 10) [34] . One study evaluated both Solitaire TM and Trevo ® stents (n = 43 and n = 26, respectively) [35] , and another study assessed both the Solitaire TM and Revive TM devices (n = 9 and n = 12, respectively) [36] .…”

“…The 4 case series included (n = 451) had a weighted mean of asymptomatic haemorrhage rate of 18 ± 8.9% [22,24,28,32] . In patients with basilar artery occlusion, only Möhlenbruch et al [36] reported a single case of asymptomatic haemorrhage.…”

“…In case series (6 studies, n = 327), the weighted mean deficit after the intervention ranged from 7 ± 6.25 to 17.5 ± 12.3 points (mean calculated from median if required) [22,27,29,30,34,35] . In a comparative case series, a minor neurological deficit was observed in patients treated with stent retrievers compared with those for whom a Merci ® retriever or rtPA was used [median (range): 7 (1-26), 12 (5-30) and 14 , respectively, p = 0.05] [35] .…”

Thrombectomy vs. Systemic Thrombolysis in Acute Embolic Stroke with High Clot Burden: A Retrospective Analysis

“…Thus, patient identification by thrombus length, not only the site of occlusion, and solely the use of highly effective stent retrievers seem to be important corner points for successful intraarterial treatment. Once more, registry studies in acute stroke using stent-based thrombectomy also revealed an increase in favorable outcome after 90 days: Leker et al found up to 60 % of patients treated by thrombectomy reaching an mRS of 0 to 2 compared to 37.5 % in patients treated by i. v. thrombolysis [18]. In a recent study a 90-day favorable outcome of even 77 % and a recanalization rate of 90 % could be achieved using the Solitaire ® device [19].…”

Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?

“…2 Accurate identification of occlusion location also enables candidate selection for mechanical endovascular therapy (MET), which may be offered for large intracranial artery occlusions. [3][4][5] Digital subtraction angiography remains the criterion standard of imaging techniques for precisely determining occlusion location. When MR imaging is used as the first-line technique in patients with acute stroke, 3D-TOF is the recommended MRA sequence for depicting the level of intracranial occlusion.…”