Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions-Reference-Cited by-同舟云学术

Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions

Published:2023-10 Issue:10 Volume:54 Page:2522-2533
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Rodriguez-Calienes Aaron¹²^ORCID,Galecio-Castillo Milagros¹^ORCID,Farooqui Mudassir¹^ORCID,Hassan Ameer E.³^ORCID,Jumaa Mouhammad A.⁴^ORCID,Divani Afshin A.⁵^ORCID,Ribo Marc⁶^ORCID,Abraham Michael⁷^ORCID,Petersen Nils H.⁸^ORCID,Fifi Johanna⁹^ORCID,Guerrero Waldo R.¹⁰^ORCID,Malik Amer M.¹¹^ORCID,Siegler James E.¹²¹³^ORCID,Nguyen Thanh N.¹⁴^ORCID,Yoo Albert J.¹⁵^ORCID,Linares Guillermo¹⁶^ORCID,Janjua Nazli¹⁷^ORCID,Quispe-Orozco Darko¹^ORCID,Tekle Wondwossen G.³^ORCID,Alhajala Hisham⁴^ORCID,Ikram Asad⁵^ORCID,Rizzo Federica⁶^ORCID,Qureshi Abid⁷^ORCID,Begunova Liza⁹^ORCID,Matsouka Stavros⁹^ORCID,Vigilante Nicholas¹²^ORCID,Salazar-Marioni Sergio¹⁸^ORCID,Abdalkader Mohamad¹⁴^ORCID,Gordon Weston¹⁶^ORCID,Soomro Jazba¹⁵^ORCID,Turabova Charoskon¹⁷^ORCID,Vivanco-Suarez Juan¹^ORCID,Mokin Maxim¹⁰^ORCID,Yavagal Dileep R.¹¹^ORCID,Jovin Tudor¹²^ORCID,Sheth Sunil¹⁸^ORCID,Ortega-Gutierrez Santiago¹⁹^ORCID

Affiliation:

1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City (A.R.-C., M.G.-C., M.F., D.Q.-O., J.V.-S.).

2. Department of Neuroscience, Clinical Effectiveness and Public Health Research Group, Universidad Científica del Sur, Lima, Peru (A.R.-C.).

3. Department of Neurology, Valley Baptist Medical Center/ University of Texas Rio Grande Valley, Harlingen, TX (A.E.H., W.G.T.).

4. Department of Neurology, ProMedica Toledo Hospital, OH (M.A.J., H.A.).

5. Department of Neurology, University of New Mexico Health Science Center, Albuquerque (A.A.D., A.I.).

6. Department of Neurology, Hospital Vall d’Hebron, Barcelona, Spain (M.R., F.R.).

7. Department of Neurology, University of Kansas Medical Center (M.A., A.Q.).

8. Department of Neurology, Yale University School of Medicine, New Haven, CT (N.H.P., L.B.).

9. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., S.M.).

10. Department of Neurology and Brain Repair, University of South Florida, Tampa (W.R.G., M.M.).

11. Department of Neurology, University of Miami Miller School of Medicine, FL (A.M.M., D.R.Y.).

12. Cooper Neurological Institute, Cooper University Hospital, Camden, NJ (J.E.S., N.V., T.J.).

13. Cooper Medical School of Rowan University, Candem, NJ (J.E.S.).

14. Department of Neurology, Boston Medical Center (T.N.N., M.A.).

15. Texas Stroke Institute, Dallas-Fort Worth (A.J.Y., J.S.).

16. Department of Neurology, Saint Louis University, St. Louis, MO (G.L., W.G.).

17. Asia Pacific Comprehensive Stroke Institute, Pomona Valley Hospital Medical Center, CA (N.J., C.T.).

18. Department of Neurology, UT Health McGovern Medical School, Houston, TX (S.S.-M., S.S.).

19. Department of Neurology, Neurosurgery & Radiology, University of Iowa Hospitals and Clinics, Iowa City (S.O.-G.).

Abstract

BACKGROUND: We aimed to describe the safety and efficacy of mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for patients with tandem lesions and whether using intraprocedural antiplatelet therapy influences MT’s safety with IVT treatment. METHODS: This is a subanalysis of a pooled, multicenter cohort of patients with acute anterior circulation tandem lesions treated with MT from 16 stroke centers between January 2015 and December 2020. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2. Additional outcomes included hemorrhagic transformation, successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3), complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3), favorable functional outcome (90-day modified Rankin Scale score 0–2), excellent functional outcome (90-day modified Rankin Scale score 0–1), in-hospital mortality, and 90-day mortality. RESULTS: Of 691 patients, 512 were included (218 underwent IVT+MT and 294 MT alone). There was no difference in the risk of sICH (adjusted odds ratio [aOR], 1.22 [95% CI, 0.60–2.51]; P =0.583), parenchymal hematoma type 2 (aOR, 0.99 [95% CI, 0.47–2.08]; P =0.985), and hemorrhagic transformation (aOR, 0.95 [95% CI, 0.62–1.46]; P =0.817) between the IVT+MT and MT alone groups after adjusting for confounders. Administration of IVT was associated with an increased risk of sICH in patients who received intravenous antiplatelet therapy (aOR, 3.04 [95% CI, 0.99–9.37]; P =0.05). The IVT+MT group had higher odds of a 90-day modified Rankin Scale score 0 to 2 (aOR, 1.72 [95% CI, 1.01–2.91]; P =0.04). The odds of successful reperfusion, complete reperfusion, 90-day modified Rankin Scale score 0 to 1, in-hospital mortality, or 90-day mortality did not differ between the IVT+MT versus MT alone groups. CONCLUSIONS: Our study showed that the combination of IVT with MT for tandem lesions did not increase the overall risk of sICH, parenchymal hematoma type 2, or overall hemorrhagic transformation independently of the cervical revascularization technique used. However, intraprocedural intravenous antiplatelet therapy during acute stent implantation might be associated with an increased risk of sICH in patients who received IVT before MT. Importantly, IVT+MT treatment was associated with a higher rate of favorable functional outcomes at 90 days.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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