title: Prior IV Thrombolysis Facilitates Mechanical Thrombectomy in Acute Ischemic Stroke.
abstract: BACKGROUND
  In acute ischemic stroke (AIS), bridging therapy, including intravenous thrombolysis (IVT) and mechanical thrombectomy (MET), appears to be very promising. However, data on the impact of IVT before the endovascular procedure are limited.
  
  
  METHODS
  To examine the impact of IVT on the MET procedure, we compared the duration of this procedure, number of passes, recanalization rate, safety issues, and outcome in consecutively recruited patients either eligible for MET alone (intravenous fibrinolysis contraindication) or receiving MET preceded by IVT for proximal middle cerebral artery (MCA) occlusion within 6 hours of stroke onset.
  
  
  RESULTS
  From January 2011 to June 2013, 68 cases with proximal MCA occlusion were available for analysis (MET alone, 40; IVT + MET, 28). The 2 groups did not differ significantly in baseline characteristics. The median National Institutes of Health Stroke Scale score at admission was 15 (10-20) for MET and 18 (13-19) for IVT + MET groups, respectively (P = .39). The median duration of the endovascular procedure (from groin puncture to recanalization) was significantly shorter in the IVT + MET group compared with that in MET alone (35 minutes [21-60] versus 60 minutes [25-91]; P = .043). The number of passes of the thrombectomy device per patient tended to be lower in the IVT + MET group than those in the MET group (P = .080). The IVT + MET group also had a higher rate of complete recanalization and a better outcome at 3 months.
  
  
  CONCLUSIONS
  Prior IVT may facilitate the MET procedure. Further studies on MET in AIS should assess the direct impact of IVT on the endovascular procedure.
authors: Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France; Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Pierre
authors: P
authors: Guedin
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Aurelie
authors: A
authors: Larcher
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Jean-Pierre
authors: JP
authors: Decroix
authors: Department of Biostatistics, Lille University Medical Center, Lille, France.
authors: Julien
authors: J
authors: Labreuche
authors: Department of Clinical Research and Innovation and Laboratory of Pharmacology, UPRES EA220, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Jean-Francois
authors: JF
authors: Dreyfus
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Serge
authors: S
authors: Evrard
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Adrien
authors: A
authors: Wang
authors: Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France; Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Philippe
authors: P
authors: Graveleau
authors: Division of Neurology, Stroke Center, Poissy Saint-Germain-En-Laye Hospital, Poissy, France.
authors: Philippe
authors: P
authors: Tassan
authors: Department of Neurology and Stroke Center, Mignot Hospital, University Versailles Saint-Quentin en Yvelines, Le Chesnay, France.
authors: Fernando
authors: F
authors: Pico
authors: Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Oguzhan
authors: O
authors: Coskun
authors: Department of Diagnostic and Interventional Neuroradiology, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Georges
authors: G
authors: Rodesch
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France.
authors: Frederic
authors: F
authors: Bourdain
authors: Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France. Electronic address: b.lapergue@hopital-foch.org.
authors: Bertrand
authors: B
authors: Lapergue
mesh_terms: D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007511:Ischemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Mechanical endovascular therapy; acute ischemic stroke - recanalization; intravenous thrombolysis by rtPA