Start, Stop, Continue? The Benefit of Overlapping Intravenous Thrombolysis and Mechanical Thrombectomy : A Matched Case-control Analysis from the German Stroke Registry.

Burian, Egon; Sepp, Dominik; Lehm, Manuel; Bernkopf, Kathleen; Wunderlich, Silke; Riederer, Isabelle; Maegerlein, Christian; Alegiani, Anna; Zimmer, Claus; Boeckh-Behrens, Tobias

doi:10.1007/s00062-022-01200-y

2023

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Dokumenttyp:: Journal Article
Autor(en):: Burian, Egon; Sepp, Dominik; Lehm, Manuel; Bernkopf, Kathleen; Wunderlich, Silke; Riederer, Isabelle; Maegerlein, Christian; Alegiani, Anna; Zimmer, Claus; Boeckh-Behrens, Tobias
Titel:: Start, Stop, Continue? The Benefit of Overlapping Intravenous Thrombolysis and Mechanical Thrombectomy : A Matched Case-control Analysis from the German Stroke Registry.
Abstract:: OBJECTIVE: Here we compare the procedural and clinical outcome of patients undergoing thrombectomy with running thrombolysis to matched controls with completed intravenous therapy and an only marginally overlapping activity. METHODS: Patients from 25 sites in Germany were included, who presented with an acute ischemic stroke. Patients' baseline characteristics (including ASPECTS, NIHSS and mRS), grade of reperfusion, and functional outcome 24 h and at day 90 after intervention were extracted from the German Stroke Registry (n = 2566). In a case-control design we stepwise matched the groups due to age, sex and time to groin puncture and time to flow restoration. RESULTS: In the initial cohort (overlap group n = 864, control group n = 1702) reperfusion status (median TICI in overlap group vs. control group: 3 vs. 2b), NIHSS after 24 h, early neurological improvement parameters, mRS at 24 h and at day 90 were significantly better in the overlap group (p < 0.001) with a similar risk of bleeding (2.9% vs. 2.4%) and death (18% vs. 22%). After adjustment mRS at day 90 still showed a trend for lower disability scores in the overlap group (3 IQR 1-5 vs. 3 IQR 1-6, p = 0.09). While comparable bleeding risk could be maintained (4% in both groups), there were significantly more deaths in the control group (18% vs. 30%, p = 0.006). CONCLUSION: The presented results support the approach of continuing and completing a simultaneous administration of intravenous thrombolysis during mechanical thrombectomy procedures.
Zeitschriftentitel:: Clin Neuroradiol
Jahr:: 2023
Band / Volume:: 33
Heft / Issue:: 1
Seitenangaben Beitrag:: 187-197
Volltext / DOI:: doi:10.1007/s00062-022-01200-y
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/35881162
Print-ISSN:: 1869-1439
TUM Einrichtung:: Institut für Diagnostische und Interventionelle Radiologie (Prof. Makowski); Klinik und Poliklinik für Neurologie (Prof. Hemmer); Professur für Neuroradiologie (Prof. Zimmer)
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