Abstract

BACKGROUND

The benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke is uncertain. Conventional metrics of final modified thrombolysis in cerebral ischemia (mTICI) score and 90-d modified Rankin Scale may be insensitive to IVT effects on procedural complexity and duration.

OBJECTIVE

To study the effect of IVT prior to MT on clot survival.

METHODS

We performed a single-center retrospective analysis of 257 acute stroke patients with LVO undergoing MT and analyzed the effect of IVT prior to MT using a novel, pass-by-pass clot survival methodology.

RESULTS

The use of IVT was associated with a significantly lower number of passes to attain mTICI 2B or greater (P = .002) or mTICI 3 (P = .039) reperfusion. The number of patients who achieved mTICI 2B or greater after the first pass was significantly higher in the IVT group (P = .003). This increased rate of reperfusion persisted into subsequent passes.

CONCLUSION

IVT prior to MT reduces the number of thrombectomy passes required to achieve mTICI 2B or mTICI 3 reperfusion. This information should be considered as the merits of IVT prior to MT are debated.

中文翻译：

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急性大血管闭塞卒中机械取栓术中静脉溶栓对血栓存活的影响

摘要

背景

对于大血管闭塞 (LVO) 卒中患者，机械取栓 (MT) 前静脉溶栓 (IVT) 的益处尚不确定。脑缺血最终改良溶栓 (mTICI) 评分和 90 天改良 Rankin 量表的常规指标可能对 IVT 对程序复杂性和持续时间的影响不敏感。

客观的

研究 MT 前 IVT 对凝块存活的影响。

方法

我们对 257 例接受 MT 的 LVO 急性脑卒中患者进行了单中心回顾性分析，并使用一种新的旁路凝块存活方法分析了 MT 前 IVT 的效果。

结果

IVT 的使用与达到 mTICI 2B 或更高 ( P  = .002) 或 mTICI 3 ( P  = .039) 再灌注的通过次数显着减少相关。在 IVT 组中，首次通过后达到 mTICI 2B 或更高的患者数量显着增加（P  = .003）。这种增加的再灌注率持续到随后的通道中。

结论

MT 之前的 IVT 减少了实现 mTICI 2B 或 mTICI 3 再灌注所需的取栓次数。该信息应被视为在 MT 之前进行 IVT 的优点有争议。