Intravenous Thrombolysis and Passes of Thrombectomy as Predictors for Endovascular Revascularization in Ischemic Stroke

J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2488-95. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.024. Epub 2016 Aug 2.


Background: Patient selection for endovascular revascularization treatment (ERT) in acute ischemic stroke depends on the expected benefit-risk ratio. As rapid revascularization is a major determinant of good functional outcome, we aimed to identify its predictors after ERT.

Methods: Consecutive stroke patients from a single stroke center with distal internal carotid artery-, proximal middle cerebral artery- or T-occlusions treated with ERT were retrospectively selected. We assessed admission noncontrast computed tomography and computed tomography angiography for thrombus location, thrombus load (clot burden score), and collateral status. Clinical data were extracted from medical charts. Univariate and multivariate regression analyses were performed to identify predictors of revascularization (thrombolysis in cerebral infarction ≥2b) after ERT.

Results: A total of 63 patients were identified (median age, 73 years; interquartile range: 62-77; 40 females). Sixteen patients (25.4%) underwent intravenous thrombolysis (ivT) before ERT. Twenty-two patients (34.9%) had additional intra-arterial application of recombinant tissue plasminogen activator. The overall recanalization rate was 66.7%, and 9.5% had symptomatic intracranial bleeding. In-hospital mortality was 15%, and 30% reached good functional outcome at discharge. In the univariate analysis, preceding ivT and the number of passes for thrombectomy (dichotomized ≤2 versus >2) were associated with recanalization. There was a trend for number of thrombectomy passes (as continuous variable) and multimodal ERT. In the multivariate regression analysis, ivT prior to ERT and passes of thrombectomy were identified as independent predictors for recanalization.

Conclusion: ivT and lower passes of thrombectomy are associated with recanalization after ERT for ischemic stroke with proximal vessel occlusions.

Keywords: Acute ischemic stroke; cerebrovascular occlusion; thrombectomy; thrombolytic therapy; tissue plasminogen activator.

MeSH terms

  • Aged
  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / therapy*
  • Chi-Square Distribution
  • Computed Tomography Angiography
  • Coronary Angiography / methods
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / mortality
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Germany
  • Hospital Mortality
  • Humans
  • Infusions, Intravenous
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Thrombosis / diagnosis
  • Intracranial Thrombosis / mortality
  • Intracranial Thrombosis / therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Multivariate Analysis
  • Odds Ratio
  • Patient Discharge
  • Patient Selection
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / therapy*
  • Thrombectomy* / adverse effects
  • Thrombectomy* / mortality
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / mortality
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator