Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions

Authors

Aaron Rodriguez-Calienes
Milagros Galecio-Castillo
Mudassir Farooqui
Ameer E. Hassan, The University of Texas Rio Grande Valley
Mouhammad A. Jumaa
Afshin A. Divani
Marc Ribo
Wondwossen G. Tekle, The University of Texas Rio Grande Valley
Hisham Alhajala
Sunil Sheth

Document Type

Article

Publication Date

10-2023

Abstract

Background: We aimed to describe the safety and efficacy of mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for patients with tandem lesions and whether using intraprocedural antiplatelet therapy influences MT's safety with IVT treatment.

Methods: This is a subanalysis of a pooled, multicenter cohort of patients with acute anterior circulation tandem lesions treated with MT from 16 stroke centers between January 2015 and December 2020. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2. Additional outcomes included hemorrhagic transformation, successful reperfusion (modified Thrombolysis in Cerebral Infarction score 2b-3), complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3), favorable functional outcome (90-day modified Rankin Scale score 0-2), excellent functional outcome (90-day modified Rankin Scale score 0-1), in-hospital mortality, and 90-day mortality.

Results: Of 691 patients, 512 were included (218 underwent IVT+MT and 294 MT alone). There was no difference in the risk of sICH (adjusted odds ratio [aOR], 1.22 [95% CI, 0.60-2.51]; P=0.583), parenchymal hematoma type 2 (aOR, 0.99 [95% CI, 0.47-2.08]; P=0.985), and hemorrhagic transformation (aOR, 0.95 [95% CI, 0.62-1.46]; P=0.817) between the IVT+MT and MT alone groups after adjusting for confounders. Administration of IVT was associated with an increased risk of sICH in patients who received intravenous antiplatelet therapy (aOR, 3.04 [95% CI, 0.99-9.37]; P=0.05). The IVT+MT group had higher odds of a 90-day modified Rankin Scale score 0 to 2 (aOR, 1.72 [95% CI, 1.01-2.91]; P=0.04). The odds of successful reperfusion, complete reperfusion, 90-day modified Rankin Scale score 0 to 1, in-hospital mortality, or 90-day mortality did not differ between the IVT+MT versus MT alone groups.

Conclusions: Our study showed that the combination of IVT with MT for tandem lesions did not increase the overall risk of sICH, parenchymal hematoma type 2, or overall hemorrhagic transformation independently of the cervical revascularization technique used. However, intraprocedural intravenous antiplatelet therapy during acute stent implantation might be associated with an increased risk of sICH in patients who received IVT before MT. Importantly, IVT+MT treatment was associated with a higher rate of favorable functional outcomes at 90 days.

Recommended Citation

Rodriguez-Calienes, A., Galecio-Castillo, M., Farooqui, M., Hassan, A. E., Jumaa, M. A., Divani, A. A., Ribo, M., Abraham, M., Petersen, N. H., Fifi, J., Guerrero, W. R., Malik, A. M., Siegler, J. E., Nguyen, T. N., Yoo, A. J., Linares, G., Janjua, N., Quispe-Orozco, D., Tekle, W. G., Alhajala, H., … Ortega-Gutierrez, S. (2023). Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions. Stroke, 54(10), 2522–2533. https://doi.org/10.1161/STROKEAHA.123.042966

Publication Title

Stroke

DOI

10.1161/STROKEAHA.123.042966

Academic Level

faculty

Mentor/PI Department

Neurology