[en] [en] BACKGROUND: Despite constant improvements in recent years, sufficient reperfusion after mechanical thrombectomy (MT) is not reached in up to 15% of patients with large vessel occlusion stroke (LVOS). The outcome of patients with unsuccessful reperfusion after MT especially after intravenous thrombolysis (IVT) use is not known. We investigated the influence of initial IVT in this particular group of patients with failed intracranial recanalization.
METHODS: We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry from January 2015 to December 2019. Patients presenting with LVOS of the anterior circulation and final modified Thrombolysis in Cerebral Infarction score (mTICI) of 0, 1 or 2a were included. Posterior circulation, isolated cervical carotid occlusions and successful reperfusions (mTICI 2b, 2c or 3) were excluded. The primary endpoint was favorable outcome (modified Rankin Scale score of 0-2) after 3 months. Secondary endpoints were safety outcomes including mortality, any intracranial hemorrhage (ICH), parenchymal hematoma (PH) and symptomatic intracranial hemorrhage (sICH) rates.
RESULTS: Among 5076 patients with LVOS treated with MT, 524 patients with insufficient recanalization met inclusion criteria, of which 242 received IVT and 282 did not. Functional outcome was improved in the MT+IVT group compared with the MT alone group, although the difference did not reach statistical significance (23.0% vs 12.9%; adjusted OR=1.82; 95% CI 0.98 to 3.38; p=0.058). However, 3 month mRS shift analysis showed a significant benefit of IVT (adjusted OR=1.68; 95% CI 1.56 to 6.54). ICH and sICH rates were similar in both groups, although PH rate was higher in the MT+IVT group (adjusted OR=3.20; 95% CI 1.56 to 6.54).
CONCLUSIONS: Among patients with LVOS in the anterior circulation and unsuccessful MT, IVT was associated with improved functional outcome even after unsuccessful MT. Despite recent trials questioning the place of IVT in the LVOS reperfusion strategy, these findings emphasize a subgroup of patients still benefiting from IVT.
Disciplines :
Neurology
Author, co-author :
Rozes, Claire; Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Maier, Benjamin; Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
Gory, Benjamin ; Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France ; INSERM U1254, Université de Lorraine, Nancy, France
Bourcier, Romain; Neuroradiology, University Hospital of Nantes, Nantes, France
Kyheng, Maeva; CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Université de Lille, Lille, Hauts-de-France, France
Labreuche, Julien; Department of Biostatistics, CHU Lille, Lille, France
Consoli, Arturo; Hopital Foch, Suresnes, Île-de-France, France
Mazighi, Mikael; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France ; Université de Paris, Paris, France
Blanc, Raphaël ; Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
Caroff, Jildaz; Department of Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
Eugene, Francois ; Radiologie, CHU Rennes, Rennes, France
Naggara, Olivier; Neuroradiology, Centre Hospitalier Sainte Anne, Paris, Île-de-France, France ; INSERM UMR 894, Paris, France
Gariel, Florent ; Neuroradiology, Bordeaux University Hospital, Bordeaux, France
Sibon, Igor; UMR 5287 CNRS, EPHE PSL Research University, Université de Bordeaux, Bordeaux, France ; Neurology Department, CHU de Bordeaux, Bordeaux, France
Lapergue, Bertrand; Hopital Foch, Suresnes, Île-de-France, France
Marnat, Gaultier ; Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France gaultier.marnat@chu-bordeaux.fr
Competing interests Outside this work: JL reports grants from Stryker, Penumbra and Microvention. MM reports personal fees from Acticor Biotech, Air liquide, Amgen and Boerhinger.
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