BACKGROUND Whether mechanical thrombectomy alone may achieve better or at least equal clinical outcome than mechanical thrombectomy combined with intravenous thrombolysis is a matter of debate. METHODS From the Italian Registry of Endovascular Stroke Treatment, we extracted all cases treated with intravenous thrombolysis followed by mechanical thrombectomy or with primary mechanical thrombectomy for anterior circulation stroke due to proximal vessel occlusion. We included only patients who would have qualified for intravenous thrombolysis. We compared outcomes of the two groups by using multivariate regression analysis and propensity score method. RESULTS We included 1148 patients, treated with combined intravenous thrombolysis and mechanical thrombectomy therapy (n = 635; 55.3%), or with mechanical thrombectomy alone (n = 513; 44.7%). Demographic and baseline clinical characteristics did not differ between the two groups, except for a shorter onset to groin puncture time (p < 0.05) in the mechanical thrombectomy group. A shift in the 90-day modified Rankin Scale distributions toward a better outcome was found in favor of the combined treatment (adjusted common odds ratio  = 1.3; 95% confidence interval: 1.04-1.66). Multivariate analyses on binary outcome show that subjects who underwent combined treatment had higher probability to survive with modified Rankin Scale 0-3 (odds ratio = 1.42; 95% confidence interval: 1.04-1.95) and lower case fatality rate (odds ratio = 0.6; 95% confidence interval: 0.44-0.9). Hemorrhagic transformation did not differ between the two groups. CONCLUSION These data seem to indicate that combined intravenous thrombolysis and mechanical thrombectomy could be associated with lower probability of death or severe dependency after three months from stroke due to large vessel occlusion, supporting the current guidelines of treating eligible patients with intravenous thrombolysis before mechanical thrombectomy.

中文翻译：

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静脉和血管内联合治疗与原发性机械血栓切除术相比。意大利急性卒中血管内治疗登记处。

背景技术单独进行机械血栓切除术能否比机械血栓切除术结合静脉溶栓治疗获得更好或至少相等的临床结果尚有争议。方法从意大利血管内卒中治疗登记处，我们提取了所有因静脉近端血管闭塞而进行静脉血栓溶解，机械血栓切除术或原发性机械血栓切除术治疗前循环卒中的病例。我们仅包括那些有资格进行静脉溶栓治疗的患者。我们使用多元回归分析和倾向评分法比较了两组的结果。结果我们纳入了1148例患者，他们接受了静脉溶栓和机械血栓切除术联合治疗（n = 635； 55.3％），或仅使用机械血栓切除术（n = 513； 44.7％）。两组的人口统计学和基线临床特征无差异，只是机械血栓切除术组腹股沟穿刺时间较短（p <0.05）。发现90天修正的Rankin量表分布向更好的结局转移，有利于联合治疗（调整后的共同优势比= 1.3； 95％置信区间：1.04-1.66）。对二元结局的多变量分析显示，接受联合治疗的受试者在改良的兰金等级0-3（几率= 1.42； 95％置信区间：1.04-1.95）和更低的病死率（几率= 0.6；病死率= 0.6）下具有更高的生存率。 95％置信区间：0.44-0.9）。两组之间的出血性转化没有差异。