Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy

Nitin Goyal, Georgios Tsivgoulis, Abhi Pandhi, Konark Malhotra, Rashi Krishnan, Muhammad F. Ishfaq, Balaji Krishnaiah, Christopher Nickele, Violiza Inoa-Acosta, Aristeidis H. Katsanos, Daniel Hoit, Lucas Elijovich, Andrei Alexandrov, Adam Arthur

Research output: Contribution to journalArticle

Abstract

Introduction: We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center. Methods: Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented. Results: A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8% vs 62.9%; p=0.023) and 3-month functional independence (modified Rankin Scale score 0-2;51.6% vs 38.2%; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33-70) vs 70 (IQR 44-98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1-1) vs 2 (IQR 1-2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98% vs 77%; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95% CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient -20.39; 95% CI -27.56 to -13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95% CI 4.46 to 48.00; p<0.001). Conclusions: IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StatePublished - Jan 1 2019

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Thrombectomy
Mechanical Thrombolysis
Reperfusion
Stroke
Equipment and Supplies
Endovascular Procedures
Groin
Punctures
Tertiary Care Centers
Linear Models

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy. / Goyal, Nitin; Tsivgoulis, Georgios; Pandhi, Abhi; Malhotra, Konark; Krishnan, Rashi; Ishfaq, Muhammad F.; Krishnaiah, Balaji; Nickele, Christopher; Inoa-Acosta, Violiza; Katsanos, Aristeidis H.; Hoit, Daniel; Elijovich, Lucas; Alexandrov, Andrei; Arthur, Adam.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalArticle

Goyal, Nitin ; Tsivgoulis, Georgios ; Pandhi, Abhi ; Malhotra, Konark ; Krishnan, Rashi ; Ishfaq, Muhammad F. ; Krishnaiah, Balaji ; Nickele, Christopher ; Inoa-Acosta, Violiza ; Katsanos, Aristeidis H. ; Hoit, Daniel ; Elijovich, Lucas ; Alexandrov, Andrei ; Arthur, Adam. / Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy. In: Journal of neurointerventional surgery. 2019.
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abstract = "Introduction: We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center. Methods: Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented. Results: A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8{\%} vs 62.9{\%}; p=0.023) and 3-month functional independence (modified Rankin Scale score 0-2;51.6{\%} vs 38.2{\%}; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33-70) vs 70 (IQR 44-98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1-1) vs 2 (IQR 1-2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98{\%} vs 77{\%}; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95{\%} CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient -20.39; 95{\%} CI -27.56 to -13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95{\%} CI 4.46 to 48.00; p<0.001). Conclusions: IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.",
author = "Nitin Goyal and Georgios Tsivgoulis and Abhi Pandhi and Konark Malhotra and Rashi Krishnan and Ishfaq, {Muhammad F.} and Balaji Krishnaiah and Christopher Nickele and Violiza Inoa-Acosta and Katsanos, {Aristeidis H.} and Daniel Hoit and Lucas Elijovich and Andrei Alexandrov and Adam Arthur",
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T1 - Impact of pretreatment with intravenous thrombolysis on reperfusion status in acute strokes treated with mechanical thrombectomy

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Pandhi, Abhi

AU - Malhotra, Konark

AU - Krishnan, Rashi

AU - Ishfaq, Muhammad F.

AU - Krishnaiah, Balaji

AU - Nickele, Christopher

AU - Inoa-Acosta, Violiza

AU - Katsanos, Aristeidis H.

AU - Hoit, Daniel

AU - Elijovich, Lucas

AU - Alexandrov, Andrei

AU - Arthur, Adam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center. Methods: Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented. Results: A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8% vs 62.9%; p=0.023) and 3-month functional independence (modified Rankin Scale score 0-2;51.6% vs 38.2%; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33-70) vs 70 (IQR 44-98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1-1) vs 2 (IQR 1-2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98% vs 77%; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95% CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient -20.39; 95% CI -27.56 to -13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95% CI 4.46 to 48.00; p<0.001). Conclusions: IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.

AB - Introduction: We sought to evaluate the impact of pretreatment with intravenous thrombolysis (IVT) on the rate and speed of successful reperfusion (SR) in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT) in a high-volume tertiary care stroke center. Methods: Consecutive patients with ELVO treated with MT were evaluated. Outcomes were compared between patients who underwent combined IVT and MT (IVT+MT) and those treated with direct MT (dMT). The elapsed time between groin puncture to beginning of reperfusion (GPTBRT) and the numbers of device passes required to achieve SR were also documented. Results: A total of 287 and 132 patients were treated with IVT+MT and dMT, respectively. The IVT+MT group had higher SR (73.8% vs 62.9%; p=0.023) and 3-month functional independence (modified Rankin Scale score 0-2;51.6% vs 38.2%; p=0.008) rates. The median GPTBRT was shorter in the IVT+MT group (48 (IQR 33-70) vs 70 (IQR 44-98) min; p<0.001). Among patients who achieved SR (n=292), the median number of required device passes was lower in the IVT+MT subgroup (1 (IQR 1-1) vs 2 (IQR 1-2); p<0.001), while the rate of patients requiring ≤2 device passes was higher (98% vs 77%; p<0.001). IVT+MT was independently related to higher odds of SR (OR 1.64; 95% CI 1.03 to 2.61; p=0.036) and shorter GPTBRT (unstandardized linear regression coefficient -20.39; 95% CI -27.56 to -13.22; p<0.001) on multivariable analyses adjusting for potential confounders. Among patients with SR, IVT+MT was independently associated with a higher likelihood of ≤2 device passes (OR 14.63; 95% CI 4.46 to 48.00; p<0.001). Conclusions: IVT pretreatment appears to increase the rates of SR and shortens the duration of the endovascular procedure by requiring fewer device passes in patients with ELVO treated with MT.

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DO - 10.1136/neurintsurg-2019-014746

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