Start, Stop, Continue? The Benefit of Overlapping Intravenous Thrombolysis and Mechanical Thrombectomy : A Matched Case-control Analysis from the German Stroke Registry.
Clin Neuroradiol
; 33(1): 187-197, 2023 Mar.
Article
em En
| MEDLINE
| ID: mdl-35881162
ABSTRACT
OBJECTIVE:
Here we compare the procedural and clinical outcome of patients undergoing thrombectomy with running thrombolysis to matched controls with completed intravenous therapy and an only marginally overlapping activity.METHODS:
Patients from 25 sites in Germany were included, who presented with an acute ischemic stroke. Patients' baseline characteristics (including ASPECTS, NIHSS and mRS), grade of reperfusion, and functional outcome 24â¯h and at day 90 after intervention were extracted from the German Stroke Registry (nâ¯= 2566). In a case-control design we stepwise matched the groups due to age, sex and time to groin puncture and time to flow restoration.RESULTS:
In the initial cohort (overlap group nâ¯= 864, control group nâ¯= 1702) reperfusion status (median TICI in overlap group vs. control group 3 vs. 2b), NIHSS after 24â¯h, early neurological improvement parameters, mRS at 24â¯h and at day 90 were significantly better in the overlap group (pâ¯< 0.001) with a similar risk of bleeding (2.9% vs. 2.4%) and death (18% vs. 22%). After adjustment mRS at day 90 still showed a trend for lower disability scores in the overlap group (3 IQR 1-5 vs. 3 IQR 1-6, pâ¯= 0.09). While comparable bleeding risk could be maintained (4% in both groups), there were significantly more deaths in the control group (18% vs. 30%, pâ¯= 0.006).CONCLUSION:
The presented results support the approach of continuing and completing a simultaneous administration of intravenous thrombolysis during mechanical thrombectomy procedures.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Acidente Vascular Cerebral
/
AVC Isquêmico
Tipo de estudo:
Observational_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article