Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke
Author:
Tong Xu1ORCID, Wang Yilong23ORCID, Fiehler Jens4, Bauer Clayton T.5, Jia Baixue1, Zhang Xuelei1, Huo Xiaochuan1, Luo Gang1, Wang Anxin3, Pan Yuesong3ORCID, Ma Ning1, Gao Feng1ORCID, Mo Dapeng1, Song Ligang1, Sun Xuan1, Liu Lian1ORCID, Deng Yiming1, Li Xiaoqing, Wang Bo, Ma Gaoting, Wang YongjunORCID, Ren Zeguang5ORCID, Miao Zhongrong1ORCID, Miao Zhongrong, Gui Liqiang, Song Cunfeng, Peng Ya, Wu Jin, Zhao Shijun, Zhao Junfeng, Zhou Zhiming, Li Yongli, Jing Ping, Yang Lei, Liu Yajie, Zhao Qingshi, Liu Yan, Peng Xiaoxiang, Gao Qingchun, Guo Zaiyu, Chen Wenhuo, Li Weirong, Cheng Xiaojiang, Xu Yun, Zhang Yongqiang, Zhang Guilian, Lu Yijiu, Lu Xinyu, Wang Dengxiang, Wang Yan, Li Hao, Hua Yang, Geng Deqin, Yuan Haicheng, Wang Hongwei, Yang Haihua, Wang Zengwu, Wei Liping, Liufu Xuancong, Shi Xiangqun, Li Juntao, Yang Wenwu, Jing Wenji, Yong Xiang, Wang Leyuan, Li Chunlei, Cao Yibin, Zhu Qingfeng, Zhang Peng, Luo Xiang, Chen Shengli, Peng WenWu, Wang Lixin, Wen Xue, Shi Shugui, Wang Wanming, Bo Wang, Yuan Pu, Wang Dong, Guan Haitao, Liang Wenbao, Ma Daliang, Chen Long, Xiao Yan, Xie Xiangdong, Shi Zhonghua, Zeng Xiangjun, Su Fanfan, Chang MingZe, Yin Jijun, Sun Hongxia, Li Chong, Bi Yong, Xie Gang, Zhao Yuwu, Wang Chao, Zhang Peng, Wang Xianjun, Li Dongqun, Liang Hui, Chen Zhonglun, Wang Yan, Xin Yu, Yin Lin, Qiu HongKai, Wei Jun, Sun Yaxuan, Feng Xiaoya, Wu Weihua, Gao Lianbo, Ai Zhibing, Lan Tan, Ding Li, Liang Qilong, Wang Zhimin, Yang Jianwen, Xu Ping, Dong Wei, Zheng Quanle, Zhu Zhenyun, Zhao Liyue, Meng Qingbo, Wei Yuqing, Chen Xianglin, Wang Wei, Sun Dong, Yan Yongxing, Yuan Guangxiong, Yang Yadong, Zhou Jianfeng, Yang Zhi, Zhang Zhenzhong, Guan Ning, Wang Huihong
Affiliation:
1. Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China. 2. Department of Neurology (Yilong Wang), Beijing Tiantan Hospital, Capital Medical University, China. 3. China National Clinical Research Center for Neurological Diseases (A.W., Y.P., Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University, China. 4. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (J.F.). 5. Department of Neurosurgery, University of South Florida, Tampa (C.T.B., Z.R.).
Abstract
Background and Purpose:
A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting.
Methods:
Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry [Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke]) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared.
Results:
A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points;
P
=0.82) and successful recanalization (86.6% versus 89.3%;
P
=0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; β=−45.02 [95% CI, −68.31 to −21.74]), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 [95% CI, 0.30–0.91]), and embolization (4.6% versus 8.1%; odds ratio, 0.54 [95% CI, 0.30–0.98]) than those of the combined group.
Conclusions:
This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03370939.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
52 articles.
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