Is intravenous thrombolysis still necessary in patients who undergo mechanical thrombectomy?

Aristeidis H. Katsanos, Georgios Tsivgoulis

Research output: Contribution to journalReview article

6 Citations (Scopus)

Abstract

Purpose of reviewTo summarize available evidence on the potential utility of pretreatment with intravenous thrombolysis (IVT) using recombinant tissue-plasminogen activator (rt-PA) in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO) who are treated with mechanical thrombectomy.Recent findingsDespite theoretical concerns of a higher bleeding risk with IVT pretreatment, there are no data showing increased risk of symptomatic intracerebral hemorrhage (sICH) in patients with LVO receiving bridging therapy (IVT and mechanical thrombectomy) compared with direct mechanical thrombectomy (dMT). Additionally, evidence from observational studies suggest lower rates of infarctions in previously unaffected territories and higher rates of successful reperfusion, with lower number of device passes, in patients receiving bridging therapy. There are substantial discrepancies in studies comparing clinical outcomes between dMT and bridging therapy that are directly related to the inclusion of patients with contraindications to IVT in the dMT group. Ongoing clinical trials will provide definitive answers on the potential additional benefit of IVT in LVO patients receiving mechanical thrombectomy.SummaryIVT and mechanical thrombectomy are two effective reperfusion therapies that should be used in a swift and noncompeting fashion in AIS patients. AIS patients with LVO and no contraindications for IVT should receive promptly rt-PA bolus followed by immediate initiation of mechanical thrombectomy as indicated by current international recommendations, unless future randomized controlled trials provide evidence to proceed differently.

Original languageEnglish (US)
Pages (from-to)3-12
Number of pages10
JournalCurrent opinion in neurology
Volume32
Issue number1
DOIs
StatePublished - Feb 1 2019

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Thrombectomy
Stroke
Tissue Plasminogen Activator
Reperfusion
Mechanical Thrombolysis
Cerebral Hemorrhage
Therapeutics
Infarction
Observational Studies
Randomized Controlled Trials
Clinical Trials
Hemorrhage
Equipment and Supplies

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Is intravenous thrombolysis still necessary in patients who undergo mechanical thrombectomy? / Katsanos, Aristeidis H.; Tsivgoulis, Georgios.

In: Current opinion in neurology, Vol. 32, No. 1, 01.02.2019, p. 3-12.

Research output: Contribution to journalReview article

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