Intravenous thrombolysis upon flow restoration improves outcome in endovascular thrombectomy

J Neurointerv Surg. 2022 Oct 28;jnis-2022-019522. doi: 10.1136/jnis-2022-019522. Online ahead of print.


Background: We hypothesized that ongoing IV thrombolysis (IVT) at flow restoration in patients with acute ischemic stroke (AIS) treated with IVT and endovascular thrombectomy (ET) is associated with improved outcome.

Methods: We included patients with IVT and successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b) after ET from an observational multicenter cohort, the German Stroke Registry - Endovascular Treatment trial. Procedural characteristics and functional outcome at discharge and 90 days were compared between patients with and without ongoing IVT at flow restoration. To determine associations with functional outcome, adjusted ORs were calculated using ordinal multivariable logistic regression models adjusted for potential baseline confounder variables.

Results: Among 1303 patients treated with IVT and ET who achieved successful recanalization, IVT was ongoing in 13.8% (n=180) at flow restoration. Ongoing IVT was associated with better functional outcome at discharge (adjusted OR 1.61; 95% CI 1.13 to 2.30) and at 90 days (adjusted OR 1.52; 95% CI 1.06 to 2.18).

Conclusion: These results provide preliminary evidence for a benefit of ongoing IVT at flow restoration in patients with AIS treated with ET.

Keywords: Stroke; Thrombectomy; Thrombolysis.