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Short and long-term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy: a prospective single-center study

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Abstract

Recent clinical trials demonstrated that mechanical thrombectomy (MT) using second-generation endovascular devices has beneficial effects in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, it remains controversial if intravenous thrombolysis (IVT) prior to MT is superior compared to direct mechanical thrombectomy (DMT). The aims of this study were to compare short and long-term outcomes between IVT + MT and DMT patients. We prospectively recruited AIS patients with LVO in the anterior or posterior circulation eligible for MT with and without prior IVT. Modified Rankin Scale (mRS) and mortality were assessed at baseline, at discharge, 90-days and 1-year after stroke. Favorable outcome was defined as a mRS score ≤2. Of the 66 patients included, 33 (50%) were in IVT + MT group and 33 (50%) were in DMT group. Except for a higher prevalence of patients using anticoagulants at admission in DMT group, baseline characteristics did not differ in the two groups. Procedural characteristics were similar in IVT + MT and DMT group. Rate of favorable outcome was significantly higher in IVT + MT patients than DMT ones both 90-days (51.5 vs. 18.2%; p = 0.004) and 1-year (51.5 vs. 15.2%; p = 0.002) after stroke. DMT patients were six times more likely to die during the 1-year follow-up compared to IVT + MT patients. This study suggests that bridging therapy may improve short and long-term outcomes in patients eligible for endovascular treatment. Further studies with larger patient numbers and randomized design are needed to confirm our findings.

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Authors and Affiliations

  1. Stroke Unit, Department of Neurosciences, Udine University Hospital, Piazzale S. Maria della Misericordia 15, 33100, Udine, Italy

    Giovanni Merlino, Michele Rana, Iacopo Cancelli, Sara Naliato, Simone Lorenzut, Roberto Marinig & Roberto Eleopra

  2. Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy

    Massimo Sponza, Alessandro Vit, Vladimir Gavrilovic & Andrea Pellegrin

  3. Division of Neuroradiology, Udine University Hospital, Udine, Italy

    Benedetto Petralia & Ferdinando Calzolari

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  1. Giovanni Merlino
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  2. Massimo Sponza
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Correspondence to Giovanni Merlino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Merlino, G., Sponza, M., Petralia, B. et al. Short and long-term outcomes after combined intravenous thrombolysis and mechanical thrombectomy versus direct mechanical thrombectomy: a prospective single-center study. J Thromb Thrombolysis 44, 203–209 (2017). https://doi.org/10.1007/s11239-017-1527-8

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  • DOI: https://doi.org/10.1007/s11239-017-1527-8

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