The administration of rtPA before mechanical thrombectomy in acute ischemic stroke patients is associated with a signifi
- PDF / 738,667 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 27 Downloads / 179 Views
The administration of rtPA before mechanical thrombectomy in acute ischemic stroke patients is associated with a significant reduction of the retrieved clot area but it does not influence revascularization outcome Rosanna Rossi1,2 · Seán Fitzgerald1 · Sara Molina1,2 · Oana Madalina Mereuta1,2 · Andrew Douglas1,2 · Abhay Pandit2 · Andreia M. Silva Santos3 · Blathnaid Murphy4 · Jack Alderson4 · Paul Brennan4 · Sarah Power4 · Alan O’Hare4 · Michael Gilvarry5 · Ray McCarthy5 · Klearchos Psychogios6 · Georgios Magoufis7 · Georgios Tsivgoulis7 · András Nagy8 · Ágnes Vadász8 · István Szikora8 · Katarina Jood9,10 · Petra Redfors9,10 · Annika Nordanstig9,10 · Erik Ceder11 · Niclas Dehlfors11 · Dennis Dunker11 · Turgut Tatlisumak9,10 · Alexandros Rentzos11 · John Thornton4 · Karen M. Doyle1,2 Accepted: 7 September 2020 © The Author(s) 2020
Abstract Both intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatments for acute ischemic stroke (AIS) in selected cases. Recanalization may occur following IVT without the necessity of further interventions or requiring a subsequent MT procedure. IVT prior to MT (bridging-therapy) may be associated with benefits or hazards. We studied the retrieved clot area and degree of recanalization in patients undergoing MT or bridging-therapy for whom it was possible to collect thrombus material. We collected mechanically extracted thrombi from 550 AIS patients from four International stroke centers. Patients were grouped according to the administration (or not) of IVT before thrombectomy and the mechanical thrombectomy approach used. We assessed the number of passes for clot removal and the mTICI (modified Treatment In Cerebral Ischemia) score to define revascularization outcome. Gross photos of each clot were taken and the clot area was measured with ImageJ software. The non-parametric Kruskal–Wallis test was used for statistical analysis. 255 patients (46.4%) were treated with bridging-therapy while 295 (53.6%) underwent MT alone. By analysing retrieved clot area, we found that clots from patients treated with bridging-therapy were significantly smaller compared to those from patients that underwent MT alone (H1 = 10.155 p = 0.001*). There was no difference between bridging-therapy and MT alone in terms of number of passes or final mTICI score. Bridging-therapy was associated with significantly smaller retrieved clot area compared to MT alone but it did not influence revascularization outcome. Keywords Thrombolysis · thrombectomy · Acute ischaemic stroke · Blood clot * Karen M. Doyle [email protected] 1
2
Department of Physiology and Galway Neuroscience Centre, School of Medicine, National University of Ireland, Galway, University Road, Galway, Ireland CÚRAM–Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
3
Centro Universitário Unievangélica, Anápolis, Goiás, Brasil
4
Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
5
Cerenovus, Galway, Irel
Data Loading...
