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Relevance of standard intravenous thrombolysis in endovascular stroke therapy of a tertiary stroke center

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Abstract

The majority of patients undergoing endovascular stroke treatment (EST) in randomized controlled trials received additional systemic thrombolysis (“combination or bridging therapy (C/BT)”). Nevertheless, its usefulness in this subtype of acute ischemic stroke (AIS) is discussed controversially. Of all consecutive AIS patients, who received any kind of reperfusion therapy in a tertiary university stroke center between January 2015 and March 2016, those with large vessel occlusions (LVO) and EST with or without additional C/BT, were compared primarily regarding procedural aspects. Data were extracted from an investigator-initiated, single-center, prospective and blinded end-point study. 70 AIS patients with EST alone and 118 with C/BT were identified. Significant baseline differences existed in pre-existing cardiovascular disease (52.9% (EST alone) vs. 35.6% (C/BT), p = 0.023), use of anticoagulation (30.6% vs. 5.9%, p < 0.001), and frequency of unknown time of symptom onset (65.7% vs. 32.2%, p < 0.001), in-hospital stroke (18.6% vs. 1.7%, p < 0.001), pre-treatment ASPECT scores (7.9 vs. 8.9, p = 0.004), and frequency of occlusion in the posterior circulation (18.6% vs. 5.1%, p = 0.003). Pre-interventional procedural time intervals tended to be shorter in the C/BT group, reaching statistical significance in door-to-image time (30.3 (EST alone) vs. 22.2 min (C/BT), p < 0.001). Good clinical outcome (mRS d90) was reached more often in the C/BT group (24.5% vs. 11.8%, p = 0.064). Rates of symptomatic intracranial hemorrhages (sICH) were comparable (4.3% (EST alone) vs. 6.8% (C/BT), p = 0.481). Additional systemic thrombolysis did not delay EST. On the contrary, application of IVRTPA seemed to be a positive indicator for faster EST without increased side effects.

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Abbreviations

IVRTPA:

Intravenous recombinant tissue plasminogen activator

EST:

Endovascular stroke therapy

C/BT:

Combination or bridging therapy

AIS:

Acute ischemic stroke

LVO:

Large vessel occlusion

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Acknowledgements

Prof. M. Wiesmann reports grants and personal fees from Stryker Neurovascular, grants and personal fees from SilkRoad Medical, grants from Covidien, grants from Microvention, grants and personal fees from Bracco, grants and personal fees from Siemens, grants from AB Medica, grants from Acandis, grants from Codman Neurovascular, grants from Penumbra, grants from Phenox, grants from Abbott, grants from St. Jude, from B. Braun, outside the submitted work.

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Author notes

  1. Annette Heinrichs and Omid Nikoubashman have equally contributed to this work.

Authors and Affiliations

  1. Department of Neurology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany

    Annette Heinrichs, Kolja Schürmann, Simone C. Tauber, Jörg B. Schulz & Arno Reich

  2. Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, 52074, Aachen, Germany

    Omid Nikoubashman & Martin Wiesmann

  3. JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany

    Jörg B. Schulz

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  1. Annette Heinrichs
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Correspondence to Arno Reich.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Heinrichs, A., Nikoubashman, O., Schürmann, K. et al. Relevance of standard intravenous thrombolysis in endovascular stroke therapy of a tertiary stroke center. Acta Neurol Belg 118, 105–111 (2018). https://doi.org/10.1007/s13760-018-0892-1

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