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Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion

Background: The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion. Purpose: To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic s...

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Main Authors: Dmytriw, Adam A. (Author) , Ghozy, Sherief (Author) , Salim, Hamza (Author) , Musmar, Basel (Author) , Siegler, James E. (Author) , Kobeissi, Hassan (Author) , Shaikh, Hamza (Author) , Khalife, Jane (Author) , Abdalkader, Mohamad (Author) , Klein, Piers (Author) , Nguyen, Thanh N. (Author) , Heit, Jeremy J. (Author) , Regenhardt, Robert W. (Author) , Cancelliere, Nicole M. (Author) , El Naamani, Kareem (Author) , Amllay, Abdelaziz (Author) , Meyer, Lukas (Author) , Dusart, Anne (Author) , Bellante, Flavio (Author) , Forestier, Geraud (Author) , Rouchaud, Aymeric (Author) , Saleme, Suzana (Author) , Mounayer, Charbel (Author) , Fiehler, Jens (Author) , Kühn, Anna Luisa (Author) , Puri, Ajit S. (Author) , Dyzmann, Christian (Author) , Kan, Peter T. (Author) , Colasurdo, Marco (Author) , Marnat, Gaultier (Author) , Berge, Jerome (Author) , Barreau, Xavier (Author) , Sibon, Igor (Author) , Nedelcu, Simona (Author) , Henninger, Nils (Author) , Marotta, Thomas R. (Author) , Stapleton, Christopher J. (Author) , Rabinov, James D. (Author) , Ota, Takahiro (Author) , Dofuku, Shogo (Author) , Yeo, Leonard L. L. (Author) , Tan, Benjamin Y. Q. (Author) , Martinez-Gutierrez, Juan Carlos (Author) , Salazar-Marioni, Sergio (Author) , Sheth, Sunil (Author) , Renieri, Leonardo (Author) , Capirossi, Carolina (Author) , Mowla, Ashkan (Author) , Adeeb, Nimer (Author) , Cuellar-Saenz, Hugo H. (Author) , Tjoumakaris, Stavropoula I. (Author) , Jabbour, Pascal (Author) , Khandelwal, Priyanka (Author) , Biswas, Arundhati (Author) , Clarencon, Frederic (Author) , Elhorany, Mahmoud (Author) , Premat, Kevin (Author) , Valente, Iacopo (Author) , Pedicelli, Alessandro (Author) , Filipe, Joao Pedro (Author) , Varela, Ricardo (Author) , Quintero-Consuegra, Miguel (Author) , Gonzalez, Nestor R. (Author) , Möhlenbruch, Markus Alfred (Author) , Jesser, Jessica (Author) , Costalat, Vincent (Author) , ter Schiphorst, Adrien (Author) , Yedavalli, Vivek S. (Author) , Harker, Pablo (Author) , Chervak, Lina M. (Author) , Aziz, Yasmin (Author) , Gory, Benjamin (Author) , Stracke, Christian Paul (Author) , Hecker, Constantin (Author) , Kadirvel, Ramanathan (Author) , Killer-Oberpfalzer, Monika (Author) , Griessenauer, Christoph J. (Author) , Thomas, Ajith (Author) , Hsieh, Cheng-Yang (Author) , Liebeskind, David S. (Author) , Radu, Răzvan Alexandru (Author) , Alexandre, Andrea M. (Author) , Tancredi, Illario (Author) , Faizy, Tobias D. (Author) , Fahed, Robert (Author) , Weyland, Charlotte S. (Author) , Lubicz, Boris (Author) , Patel, Aman B. (Author) , Pereira, Vitor Mendes (Author) , Guenego, Adrien (Author)
Format: Article (Journal)
Language:English
Published: August 6, 2024
In: Radiology
Year: 2024, Volume: 312, Issue: 2, Pages: 1-10
ISSN:1527-1315
DOI:10.1148/radiol.233041
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1148/radiol.233041
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Author Notes:Adam A. Dmytriw, Sherief Ghozy, Hamza Adel Salim, Basel Musmar, James E. Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Geraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kuhn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jerome Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Nimer Adeeb, Hugo H. Cuellar-Saenz, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frederic Clarencon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, Joao Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. Mohlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng-Yang Hsieh, David S. Liebeskind, Razvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego

MARC

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245 1 0 |a Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion  |c Adam A. Dmytriw, Sherief Ghozy, Hamza Adel Salim, Basel Musmar, James E. Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Geraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kuhn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jerome Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Nimer Adeeb, Hugo H. Cuellar-Saenz, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frederic Clarencon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, Joao Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. Mohlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Cheng-Yang Hsieh, David S. Liebeskind, Razvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego 
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520 |a Background: The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion. Purpose: To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion. Materials and Methods: This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes. Results: After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, P <.001) and onset to recanalization (397 vs 273 minutes, P <.001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; P =.019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; P =.054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; P =.17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; P =.055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; P =.16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; P =.29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; P =.21). Conclusion: Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. (c) RSNA, 2024 
650 4 |a Alteplase 
650 4 |a Efficacy 
650 4 |a Endovascular thrombectomy 
650 4 |a Intravenous thrombolysis 
650 4 |a Mechanical thrombectomy 
650 4 |a Metaanalysis 
650 4 |a Safety 
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Dmytriw, Sherief Ghozy, Hamza Adel Salim, Basel Musmar, James E. Siegler, Hassan Kobeissi, Hamza Shaikh, Jane Khalife, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Nicole M. Cancelliere, Kareem El Naamani, Abdelaziz Amllay, Lukas Meyer, Anne Dusart, Flavio Bellante, Geraud Forestier, Aymeric Rouchaud, Suzana Saleme, Charbel Mounayer, Jens Fiehler, Anna Luisa Kuhn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jerome Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Thomas R. Marotta, Christopher J. Stapleton, James D. Rabinov, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Nimer Adeeb, Hugo H. Cuellar-Saenz, Stavropoula I. Tjoumakaris, Pascal Jabbour, Priyank Khandelwal, Arundhati Biswas, Frederic Clarencon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, Joao Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. Mohlenbruch, Jessica Jesser, Vincent Costalat, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Lina M. Chervak, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Ramanathan Kadirvel, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Ajith J. Thomas, Chen 
JSO |a g-Yang Hsieh, David S. Liebeskind, Razvan Alexandru Radu, Andrea M. Alexandre, Illario Tancredi, Tobias D. Faizy, Robert Fahed, Charlotte Weyland, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Adrien Guenego"]},"origin":[{"dateIssuedKey":"2024","dateIssuedDisp":"August 6, 2024"}],"relHost":[{"part":{"extent":"10","pages":"1-10","issue":"2","text":"312(2024), 2, Artikel-ID e233041, Seite 1-10","year":"2024","volume":"312"},"language":["eng"],"pubHistory":["1.1923 -"],"note":["Fortsetzung der Druck-Ausgabe","Gesehen 07.11.22"],"corporate":[{"display":"Radiological Society of North America","role":"isb"}],"disp":"Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel OcclusionRadiology","type":{"bibl":"periodical","media":"Online-Ressource"},"name":{"displayForm":["The Radiological Society of North America"]},"recId":"320487253","id":{"zdb":["2010588-5"],"eki":["320487253"],"issn":["1527-1315"]},"physDesc":[{"extent":"Online-Ressource"}],"title":[{"title_sort":"Radiology","title":"Radiology"}],"origin":[{"publisher":"Soc.","dateIssuedDisp":"1923-","dateIssuedKey":"1923","publisherPlace":"Oak Brook, Ill."}]}],"physDesc":[{"extent":"10 S."}],"id":{"doi":["10.1148/radiol.233041"],"eki":["1951237986"]},"type":{"media":"Online-Ressource","bibl":"article-journal"},"title":[{"title_sort":"Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion","title":"Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion"}]} 
SRT |a DMYTRIWADAASSESSMENT6202 

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