Intravenous Thrombolysis Facilitates Successful Recanalization with Stent-Retriever Mechanical Thrombectomy in Middle Cerebral Artery Occlusions
Section snippets
Materials and Methods
We screened the prospectively kept neurointerventional databases of 2 German stroke centers for all ischemic stroke patients presenting within 6 hours from symptom onset who underwent MT for an imaging-proven large-artery occlusion in the anterior circulation between July 2012 and December 2013. The administration of IVT was independent from the indication for MT and was performed by the treating stroke neurologist on the basis of the national guidelines of the Deutsche Gesellschaft für
Overview
We identified 93 patients who fulfilled the inclusion criteria; the site of occlusion was MCA (proximal M1 occlusion, distal M1 occlusion, and M2) in all cases.
Baseline Characteristics
We compared the baseline characteristics age, sex, NIHSS score on admission, and time from symptom onset to groin puncture of all patients who received IVT to those who did not receive IVT before MT. There were no statistically significant differences in patient baseline characteristics overall and by site of occlusion between the groups
Discussion
MT for the treatment of large-artery occlusions in acute ischemic stroke has been used in clinical practice for several years. Its efficacy, clinical results and complications have been investigated in several studies including large case series, postmarket registries, and prospective randomized clinical trials.7, 8, 18, 19 Recently, several randomized trials that utilized mostly or exclusively stent–retriever-based MT showed a benefit for MT versus non-MT in the setting of guideline-based best
Conclusion
Concomitant IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion. The current practice of IVT in eligible patients before MT should not be abandoned unless proven otherwise by future studies, now that more evidence for the beneficial effect of MT in ischemic stroke is available.
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2022, Journal of NeuroradiologyCitation Excerpt :Thrombus migration (T-Mig) has therefore been a subject of attention as a potential MT treatment-effect modifier. T-Mig is estimated to occur in approximately 20-30% of patients referred for MT, but with yet a lack of agreement on its effects on MT technical success as well as clinical outcomes.6,8,9 In previous works the definition of T-Mig varied from “a shift to a more distal conventional angiography target occlusion than the initial target occlusion”,7 to composite parenchymal and vascular indicators of T-Mig,8 but to our knowledge no there's not been reports of quantitative T-Mig assessments with regards to clinical outcome, and procedural metrics, while such an approach may give more precise insights into the mechanisms of this phenomenon.
D. Behme and C. Kabbasch contributed equally to the work.
D. Behme, A. Kowoll, and W. Weber changed departments in 2014; the patients were treated in Recklinghausen (teaching hospital of the Ruhr University Bochum) and Cologne.
Conflicts of interest: D. Behme and A. Kowoll received minor travel grants from Penumbra. T. Liebig was a consultant for Sequent, Stryker, and Acandis. W. Weber was a consultant for Sequent, Microvention, and Phenox, and received speaking honoraria and travel grants from Penumbra. A. Mpotsaris received modest speaker honoraria from Penumbra and was a consultant for Sequent and Neuravi.