Abstract TP5: Comparison of Primary Intraarterial Thrombectomy and Intravenous Thrombolysis Bridging with Intraarterial Thrombectomy for Acute Ischemic Stroke
Background and purpose: It is not well-known whether intravenous thrombolysis (IVT) bridging with intraarterial mechanical thrombectomy (IAT) is more beneficial than primary IAT presenting within 3 hours after acute ischemic stroke. We assessed the safety and benefit of primary IAT in clinical outcomes by the comparison with bridging IVT-IAT.
Methods: Clinical data of 65 patients (43; primary IVT, 22; primary IAT), who were underwent thrombolysis for the acute internal carotid (ICA) and/or middle cerebral (MCA) artery occlusions within 3hours from the symptom onset, were evaluated. IAT was performed using retrievable intracranial stent to remove thrombus impacted within ICA or MCA. Recanalization rate and hemorrhagic transformation after thrombectomy, and modified Rankin scale (mRS) checked at discharge and 3 months after discharge were compared between patients received primary IAT or bridging IVT-IAT.
Results: Among primary IVT group, only 6 (14%) showed symptom improvement after IVT. In the other 37 patients, 26 patients were underwent additional IAT (bridging IVT-IAT group). Primary IAT and bridging IVT-IAT groups showed similar recanlization rate (IVT-IAT; 85%, IAT; 82%, p=0.548) and symptomatic intracerebral hemorrhage rate (IVT-IAT; 3.8%, IAT; 0%, p=0.421). The rate of favorable clinical outcome (mRS 0-2) was not different at discharge (IVT; 30%, IAT; 32%, p=0.556) and 3 months (IAT; 40%, IAT; 46%, p=0.472) after discharge in both groups.
Conclusions: In conclusion, the safety and clinical outcome of primary IAT was not inferior to bridging IVT-IAT for large intracerebral artery occlusions. This study suggested primary IAT, when it can be accomplished promptly, should be considered as a treatment within 3 hours.
- © 2012 by American Heart Association, Inc.