Forschung & Innovation
Publikationen
Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion
PMU Autor*innen
Constantin Hecker, Christoph J. Griessenauer, Monika Killer-Oberpfalzer
Alle Autor*innen
Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Dhairya Lakhani, Orabi Hajjeh, Basel Musmar, Nimer Adeeb, Fathi Milhem, Davide Simonato, Yan-Lin Li, Muhammed Amir Essibayi, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard L. Yeo, Benjamin Y. Q. Tan, Robert W. Regenhardt, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, Joao Pedro Filipe, Pablo Harker, Razvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Takahiro Ota, Ashkan Mowla, Kareem El Naamani, Pascal Jabbour, Arundhati Biswas, Frederic Clarencon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R. Gonzalez, Markus A. Mohlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Christoph J. Griessenauer, , Monika Killer-Oberpfalzer
Fachzeitschrift
CLINICAL NEURORADIOLOGY
Kurzfassung
BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.MethodsWe conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included AIS patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0-1 or 0-2.ResultsThe study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT. Logistic regression analysis revealed no significant differences in clinical outcomes between groups. The odds ratios (ORs) for achieving a 90-day mRS of 0-1 and 0-2 were 1.55 (95% CI 0.62 to 3.87; p = 0.34) and 1.55 (95% CI 0.72 to 3.37; p = 0.26), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.64, 95% CI 0.28 to 1.47; p = 0.29), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.39, 95% CI 0.71 to 2.73; p = 0.34).ConclusionsIn AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT preceding MT is safe in this context, it may not improve outcomes for patients with unsuccessful MT.
Keywords
INTRAVENOUS THROMBOLYSIS, MECHANICAL THROMBECTOMY, Acute Ischemic Stroke, Distal Medium Vessel Occlusion, Middle Cerebral Artery, Modified Rankin Scale