Journal Article

E-109 Combined intra-venous and intra-arterial thrombolysis versus intra-venous thrombolysis alone in stroke patients underwent mechanical thrombectomy: a propensity-matched analysis

Isidor, J, Orscelik, A, Romano, D, Moss, M, Polifka, A, Levitt, M, Navia, P, Chowdhry, S, Alawieh, A, Ezzeldin, M, Fragata, I, Cunningham, C, Psychogios, M, Altschul, D, Maier, I, Daglioglu, E, Yoshimura, S, Mascitelli, J, Starke, R, Cuellar, H, Spiotta, A, Kan, P, Alaraj, A, Elawady, S, Mulpur, B, Rai, A, Jabbour, P, Howard, B, Abo Kasem, R, Matouk, C, Matsukawa, H, Crosa, R, Kim, J, Tanweer, O, Grandhi, R, Goyal, N, Osbun, J, Siddiqui, F, De Leacy, R, Sowlat, M, Nawabi, N, Samaniego, E, Wolfe, S, Williamson, R, Park, M, Brinjikji, W

2024

Overview

IntroductionMechanical thrombectomy (MT) for acute ischemic stroke (AIS) combining intravenous (IV) or intra-arterial (IA) thrombolysis has been studied recently. However, no study has explored the outcomes of combining both IV and IA thrombolysis with MT.MethodsData from Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023 was utilized. We compared AIS patients with LVO who underwent MT and combined IVT and IAT with those who underwent MT with IVT only. We performed propensity score (PS) matching between the two groups using age, sex, premorbid mRS, admission NIHSS, occluded vessel, ASPECTS score, time from symptoms onset to arterial puncture, and frontline technique. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement, any ICH, mRS 0–1, and 90-day mortality.ResultsA total of 2495 LVO-related AIS patients were included, consisting of the IA+IV group (n = 266) and the IV group (n = 2228). Propensity matching yielded 192 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.61–1.52, p = 0.60; OR: 0.92, 95% CI:0.42–2.03, p > 0.90, respectively). The IA+IV group had a significantly lower proportion of successful recanalization (OR:0.41, 95% CI: 0.27–0.62, p < 0.001), and early neurological improvement (OR: 0.55, 95% CI: 0.30–1.00). However, 90-daymRS 0–2, mRS 0–1, and mortality rates showed no significant differences between the two groups.ConclusionThis study suggests that the combined use of IAT and IVT in AIS patients undergoing MT is safe. Although the MT+IVT+IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the MT+IVT group, indicating a potential delayed benefit of additional IAT therapy.Disclosures R. Abo Kasem: None. S. Elawady: None. B. Mulpur: None. H. Matsukawa: None. C. Cunningham: None. M. Sowlat: None. A. Orscelik: None. N. Nawabi: None. J. Isidor: None. I. Maier: 3; C; speakers’ honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. S. Yoshimura: 6; C; received lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention Inc, Medtronic Inc. Educational/Research Grants: Q’apel Inc, Steinberg Foundation. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. M. Park: 2; C; Consultant for Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereota. W. Brinjikji: 1; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He rec. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Syn. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 2; C; Consultant for MicroVention, Stryker, and Cerenovus. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus. N. Goyal: None.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Aneurysms / Equity stake / Grants / Mortality / SNIS 21st annual meeting electronic poster abstracts / Stroke / Thrombolytic drugs