Intra-arterial thrombolysis or stent placement during endovascular treatment for acute ischemic stroke leads to the highest recanalization rate: results of a multicenter retrospective study

Neurosurgery. 2011 Jun;68(6):1618-22; discussion 1622-3. doi: 10.1227/NEU.0b013e31820f156c.


Background: Reperfusion therapy for acute ischemic stroke (AIS) is rapidly evolving, with the development of multiple endovascular modalities that can be used alone or in combination.

Objective: To determine which pharmacologic or mechanical modality may be associated with increased rates of recanalization.

Methods: A cohort of 1122 patients with AIS involving the anterior circulation treated at 13 stroke centers underwent intra-arterial (IA) therapy within 8 hours of symptom onset. Demographic information, admission National Institutes of Health Stroke Scale (NIHSS), mechanical and pharmacologic treatments used, recanalization grade, and hemorrhagic complications were recorded.

Results: The mean age was 67 ± 16 years and the median NIHSS was 17. The sites of arterial occlusion before treatment were M1 middle cerebral artery (MCA) in 561 (50%) patients, carotid terminus in 214 (19%) patients, M2 MCA in 171 (15%) patients, tandem occlusions in 141 (13%) patients, and isolated extracranial internal carotid artery occlusion in 35 (3%) patients. Therapeutic interventions included multimodal therapy in 584 (52%) patients, pharmacologic therapy only in 264 (24%) patients, and mechanical therapy only in 274 (24%) patients. Patients treated with multimodal therapy had a significantly higher Thrombolysis in Myocardial Infarction 2 or 3 recanalization rate (435 patients [74%]) compared with pharmacologic therapy only (160 patients, [61%]) or mechanical only therapy (173 patients [63%]), P<.001. In binary logistic regression modeling, independent predictors of Thrombolysis in Myocardial Infarction 2 or 3 recanalization were use of IA thrombolytic OR 1.58 (1.21-2.08), P<.001 and stent deployment 1.91 (1.23-2.96), P<.001.

Conclusion: Multimodal therapy has significantly higher recanalization rates compared with pharmacologic or mechanical therapy. Among the individual treatment modalities, stent deployment or IA thrombolytics increase the chance of recanalization.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Endovascular Procedures / methods*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Stroke / therapy*
  • Thrombolytic Therapy / methods*
  • Tissue Plasminogen Activator / administration & dosage
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator