title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia 30303, USA. rishi.gupta@emory.edu
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Ashis H
authors.initials: AH
authors.lastname: Tayal
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Esteban
authors.initials: E
authors.lastname: Cheng-Ching
authors.forename: Ansaar
authors.initials: A
authors.lastname: Rai
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hsu
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.forename: Ridwan
authors.initials: R
authors.lastname: Lin
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Ashish
authors.initials: A
authors.lastname: Nanda
authors.forename: Melissa
authors.initials: M
authors.lastname: Tian
authors.forename: Qing
authors.initials: Q
authors.lastname: Hao
authors.forename: Alex
authors.initials: A
authors.lastname: Abou-Chebl
authors.forename: Junaid S
authors.initials: JS
authors.lastname: Kalia
authors.forename: Thanh N
authors.initials: TN
authors.lastname: Nguyen
authors.forename: Michael
authors.initials: M
authors.lastname: Chen
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator