Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study
Abstract First pass effect (FPE) is a successful recanalization (mTICI ≥ 2b) after the first trial of thrombectomy. It is associated with good functional outcomes. Few studies discussed the effect of BT (bridging therapy: combined I.V. thrombolysis and mechanical thrombectomy) on FPE and clinical ou...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-12-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-25696-z |
| _version_ | 1828278238633263104 |
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| author | Islam EL Malky Mahmoud Abdelhafiz Hazem Mo. Abdelkhalek |
| author_facet | Islam EL Malky Mahmoud Abdelhafiz Hazem Mo. Abdelkhalek |
| author_sort | Islam EL Malky |
| collection | DOAJ |
| description | Abstract First pass effect (FPE) is a successful recanalization (mTICI ≥ 2b) after the first trial of thrombectomy. It is associated with good functional outcomes. Few studies discussed the effect of BT (bridging therapy: combined I.V. thrombolysis and mechanical thrombectomy) on FPE and clinical outcomes. In our study, we would like to report the effect of MT with or without preceding IVT on FPE and the functional outcome of AIS (Acute Ischemic Stroke) of anterior circulation in real practice. A dual-center retrospective cohort study enrolled 201 patients with AIS of anterior circulation and was divided into a bridging therapy (BT) group of 150 patients who received alteplase preceding thrombectomy, and a direct mechanical thrombectomy (dMT) group of 51 patients. Comparisons between both groups regarding the clinical and radiological outcome. Early better clinical outcome (mRS ≤ 2) at day seven with BT group (39.3%) rather than dMT (23.5%) with P value = 0.044. No significant differences as regard puncture to revascularization time, successful revascularization (mTICI) ≥ 2b and FPE between both groups (P value: 0.328, 0.538, and 0.708, respectively). No differences as regards hemorrhagic transformation, mortality rate, and 90-day favorable outcome between both groups (P value 0.091, 0.089, and 0.192, respectively). BT might have better early outcome than dMT but no difference as regards 90-day favorable outcomes, mortality, sICH, FPE, recanalization rate and procedure time. It might be reasonable to go directly to mechanical thrombectomy without IVT for AIS with large vessel occlusion. |
| first_indexed | 2024-04-13T07:27:31Z |
| format | Article |
| id | doaj.art-fa1808496f014176a00572ff7ee7bdad |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-13T07:27:31Z |
| publishDate | 2022-12-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-fa1808496f014176a00572ff7ee7bdad2022-12-22T02:56:26ZengNature PortfolioScientific Reports2045-23222022-12-011211610.1038/s41598-022-25696-zIntravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort studyIslam EL Malky0Mahmoud Abdelhafiz1Hazem Mo. Abdelkhalek2Department of Neurology, South Valley UniversityDepartment of Neurology, South Valley UniversityDepartment of Neurology, Tanta UniversityAbstract First pass effect (FPE) is a successful recanalization (mTICI ≥ 2b) after the first trial of thrombectomy. It is associated with good functional outcomes. Few studies discussed the effect of BT (bridging therapy: combined I.V. thrombolysis and mechanical thrombectomy) on FPE and clinical outcomes. In our study, we would like to report the effect of MT with or without preceding IVT on FPE and the functional outcome of AIS (Acute Ischemic Stroke) of anterior circulation in real practice. A dual-center retrospective cohort study enrolled 201 patients with AIS of anterior circulation and was divided into a bridging therapy (BT) group of 150 patients who received alteplase preceding thrombectomy, and a direct mechanical thrombectomy (dMT) group of 51 patients. Comparisons between both groups regarding the clinical and radiological outcome. Early better clinical outcome (mRS ≤ 2) at day seven with BT group (39.3%) rather than dMT (23.5%) with P value = 0.044. No significant differences as regard puncture to revascularization time, successful revascularization (mTICI) ≥ 2b and FPE between both groups (P value: 0.328, 0.538, and 0.708, respectively). No differences as regards hemorrhagic transformation, mortality rate, and 90-day favorable outcome between both groups (P value 0.091, 0.089, and 0.192, respectively). BT might have better early outcome than dMT but no difference as regards 90-day favorable outcomes, mortality, sICH, FPE, recanalization rate and procedure time. It might be reasonable to go directly to mechanical thrombectomy without IVT for AIS with large vessel occlusion.https://doi.org/10.1038/s41598-022-25696-z |
| spellingShingle | Islam EL Malky Mahmoud Abdelhafiz Hazem Mo. Abdelkhalek Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study Scientific Reports |
| title | Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study |
| title_full | Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study |
| title_fullStr | Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study |
| title_full_unstemmed | Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study |
| title_short | Intravenous thrombolysis before thrombectomy in acute ischemic stroke: a dual centre retrospective cohort study |
| title_sort | intravenous thrombolysis before thrombectomy in acute ischemic stroke a dual centre retrospective cohort study |
| url | https://doi.org/10.1038/s41598-022-25696-z |
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