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. Results— We included 22 patients treated with SBT and 66 treated with tPA. Patients treated with SBT had higher admission National Institutes of Health Stroke Scale scores (median 21 vs 14.5; P <0.001) and prolonged symptom onset-to-treatment times (median 240 vs 95 minutes; P <0.001). At discharge, the magnitude of change in National Institutes of Health Stroke Scale was larger in the thrombectomy group (median 12 vs 6 points; P <0.001). At 90 days poststroke there was a shift toward favorable outcome in the thrombectomy group (60% vs 37.5%; P =0.001). Treatment allocation did not impact outcome in the regression analysis. Conclusions— Treatment of patients with proximal middle cerebral artery occlusions with SBT resulted in a shift toward more favorable outcomes compared with tPA. Randomized controlled studies are needed to explore whether treatment with SBT should be used in patients presenting within the first hours after stroke.