Language

English

Publication Date

9-1-2024

Journal

Stroke: Vascular and Interventional Neurology

DOI

10.1161/SVIN.124.001334

PMID

41586281

PMCID

PMC12778559

PubMedCentral® Posted Date

7-16-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Multiple randomized trials could not establish the noninferiority of endovascular thrombectomy (EVT) alone without preceding intravenous thrombolysis (IVT) or superiority of IVT followed by EVT in anterior circulation large-vessel occlusion stroke. The role of prior IVT in posterior circulation large-vessel occlusion remains controversial.

Methods: In this multicenter, retrospective study, patients with stroke with large-vessel occlusion in the posterior circulation who received EVT alone or with IVT were selected from the stroke thrombectomy and aneurysm registry between 2013 and 2022. Effects of IVT followed by thrombectomy on favorable functional outcome (defined as modified Rankin scale≤3 at 90 days) and safety were investigated using multivariable logistic and linear regression models.

Results: Of the 588 included patients, 67% (n = 394) were treated with EVT alone and 29% (n = 170) with EVT after IVT, and 4% (n = 24) have missing values on this variable. Controlling for multiple confounding factors, IVT was not associated with a higher likelihood of favorable functional outcome at 90 days (odds ratio, 1.04 [95% CI, 0.52-2.09; P = 0.901). Thrombectomy alone did not show any safety advantages compared with those receiving IVT.

Conclusion: Similar functional outcomes and complication rates were seen in patients with posterior circulation large-vessel occlusion treated with EVT alone versus EVT after IVT. Further prospective studies are required to determine the utility of IVT in posterior circulation stroke, especially in patients being directly admitted to thrombectomy centers.

Keywords

endovascular thrombectomy, intravenous thrombolysis, multicenter, posterior circulation stroke

Published Open-Access

yes

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