Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion
Background and Purpose The additive effects of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) remain unclear. We aimed to investigate the efficacy and safety of IVT prior to MT depending on the location of M1 occlusion. Methods We reviewed the cases of patients who underwent MT f...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Stroke Society
2024-01-01
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| Series: | Journal of Stroke |
| Subjects: | |
| Online Access: | http://www.j-stroke.org/upload/pdf/jos-2023-01529.pdf |
| _version_ | 1827355991714299904 |
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| author | Jae-Chan Ryu Boseong Kwon Yunsun Song Deok Hee Lee Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim |
| author_facet | Jae-Chan Ryu Boseong Kwon Yunsun Song Deok Hee Lee Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim |
| author_sort | Jae-Chan Ryu |
| collection | DOAJ |
| description | Background and Purpose The additive effects of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) remain unclear. We aimed to investigate the efficacy and safety of IVT prior to MT depending on the location of M1 occlusion. Methods We reviewed the cases of patients who underwent MT for emergent large-vessel occlusion of the M1 segment. Baseline characteristics as well as clinical and periprocedural variables were compared according to the location of M1 occlusion (i.e., proximal and distal M1 occlusion). The main outcome was the achievement of functional independence (modified Rankin Scale score, 0–2) at 3 months after stroke. The main outcomes were compared between the proximal and distal groups based on the use of IVT before MT. Results Among 271 patients (proximal occlusion, 44.6%; distal occlusion, 55.4%), 33.9% (41/121) with proximal occlusion and 24.7% (37/150) with distal occlusion underwent IVT prior to MT. Large-artery atherosclerosis was more common in patients with proximal M1 occlusion; cardioembolism was more common in those with distal M1 occlusion. In patients with proximal M1 occlusion, there was no association between IVT before MT and functional independence. In contrast, there was a significant association between the use of IVT prior to MT (odds ratio=5.30, 95% confidence interval=1.56–18.05, P=0.007) and functional independence in patients with distal M1 occlusion. Conclusion IVT before MT was associated with improved functional outcomes in patients with M1 occlusion, especially in those with distal M1 occlusion but not in those with proximal M1 occlusion. |
| first_indexed | 2024-03-08T04:51:55Z |
| format | Article |
| id | doaj.art-b76f59e7bf6b41268d9571a54b1108f8 |
| institution | Directory Open Access Journal |
| issn | 2287-6391 2287-6405 |
| language | English |
| last_indexed | 2024-03-08T04:51:55Z |
| publishDate | 2024-01-01 |
| publisher | Korean Stroke Society |
| record_format | Article |
| series | Journal of Stroke |
| spelling | doaj.art-b76f59e7bf6b41268d9571a54b1108f82024-02-08T04:10:26ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052024-01-01261758610.5853/jos.2023.01529506Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 OcclusionJae-Chan Ryu0Boseong Kwon1Yunsun Song2Deok Hee Lee3Jun Young Chang4Dong-Wha Kang5Sun U. Kwon6Jong S. Kim7Bum Joon Kim8 Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaBackground and Purpose The additive effects of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) remain unclear. We aimed to investigate the efficacy and safety of IVT prior to MT depending on the location of M1 occlusion. Methods We reviewed the cases of patients who underwent MT for emergent large-vessel occlusion of the M1 segment. Baseline characteristics as well as clinical and periprocedural variables were compared according to the location of M1 occlusion (i.e., proximal and distal M1 occlusion). The main outcome was the achievement of functional independence (modified Rankin Scale score, 0–2) at 3 months after stroke. The main outcomes were compared between the proximal and distal groups based on the use of IVT before MT. Results Among 271 patients (proximal occlusion, 44.6%; distal occlusion, 55.4%), 33.9% (41/121) with proximal occlusion and 24.7% (37/150) with distal occlusion underwent IVT prior to MT. Large-artery atherosclerosis was more common in patients with proximal M1 occlusion; cardioembolism was more common in those with distal M1 occlusion. In patients with proximal M1 occlusion, there was no association between IVT before MT and functional independence. In contrast, there was a significant association between the use of IVT prior to MT (odds ratio=5.30, 95% confidence interval=1.56–18.05, P=0.007) and functional independence in patients with distal M1 occlusion. Conclusion IVT before MT was associated with improved functional outcomes in patients with M1 occlusion, especially in those with distal M1 occlusion but not in those with proximal M1 occlusion.http://www.j-stroke.org/upload/pdf/jos-2023-01529.pdfmechanical thrombectomyproximal m1distal m1intravenous thrombolysistissue plasminogen activator |
| spellingShingle | Jae-Chan Ryu Boseong Kwon Yunsun Song Deok Hee Lee Jun Young Chang Dong-Wha Kang Sun U. Kwon Jong S. Kim Bum Joon Kim Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion Journal of Stroke mechanical thrombectomy proximal m1 distal m1 intravenous thrombolysis tissue plasminogen activator |
| title | Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion |
| title_full | Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion |
| title_fullStr | Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion |
| title_full_unstemmed | Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion |
| title_short | Effect of Intravenous Thrombolysis Prior to Mechanical Thrombectomy According to the Location of M1 Occlusion |
| title_sort | effect of intravenous thrombolysis prior to mechanical thrombectomy according to the location of m1 occlusion |
| topic | mechanical thrombectomy proximal m1 distal m1 intravenous thrombolysis tissue plasminogen activator |
| url | http://www.j-stroke.org/upload/pdf/jos-2023-01529.pdf |
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