title: Thrombectomy vs. Systemic Thrombolysis in Acute Embolic Stroke with High Clot Burden: A Retrospective Analysis.
abstract: OBJECTIVE
  The efficacy of i. v. thrombolysis in acute stroke with high clot burden is limited. Successful recanalization is very unlikely if the thrombus length exceeds 7 mm. Thus this retrospective controlled study evaluated the efficacy and safety of neurothrombectomy in the treatment of acute embolic stroke in patients selected by a thrombus length of ≥ 8 mm using the stent retriever Trevo(®) device.
  
  
  METHODS
  40 patients with acute occlusion of the anterior intracranial arteries with a thrombus length of ≥ 8 mm were treated with neurothrombectomy. We compared the outcome with a historical cohort of 42 patients with a thrombus length of ≥ 8 mm that received i. v. thrombolysis only. Clinical outcome was assessed by modified Rankin scale in both groups at discharge and on day 90.
  
  
  RESULTS
  Patients did not differ in age, mRS on admission, thrombus length or time from symptom onset to i. v. thrombolysis, but the thrombectomy group had higher NIHSS on admission. Successful recanalization was achieved in 33/40 patients (83 %) with neurothrombectomy. 15 patients received i. v. thrombolysis prior to neurothrombectomy. Median mRS at discharge was 3.5 (1.25 - 5) vs. 5 (4 - 6; p < 0.01) and on day 90 3 (1 - 4) vs. 5 (4 - 6; p < 0.01). Symptomatic hemorrhage occurred in 3 vs. 7 patients. 3 vs. 17 patients died within 90 days (thrombectomy vs. control each). There were only a few intervention-related complications.
  
  
  CONCLUSIONS
  Thrombectomy in acute stroke with high clot burden using the Trevo(®) device has a low risk and improved clinical outcome compared to i. v. thrombolysis alone. Treatment selection by a clot length of ≥ 8 mm might be a powerful approach to improve the outcome of mechanical thrombectomy.
  
  
  CONCLUSIONS
  • Clot length of ≥ 8 mm might be a valuable criterion for indicating neurothrombectomy. • Thrombolysis only in high clot burden is associated with poor clinical outcome. • Thrombectomy using the Trevo(®) stent retriever is safe and effective.
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: J K
authors.initials: JK
authors.lastname: Meyne
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: P R
authors.initials: PR
authors.lastname: Zimmermann
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Rohr
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Riedel
authors.affiliation: Department of Neurology, FEK Neumünster, Germany.
authors.forename: H C
authors.initials: HC
authors.lastname: Hansen
authors.affiliation: Department of Neurology, Imland Klinik, Rendsburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Pulkowski
authors.affiliation: Department of Neurology, Klinikum Itzehoe, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Thie
authors.affiliation: Department of Internal Medicine, Klinik Preetz, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Holst
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Papengut
authors.affiliation: Department of Neurology, DRK Kliniken Berlin, Berlin, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Stingele
authors.affiliation: Department of Neurology, Helios Klinik, Schleswig, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schepelmann
authors.affiliation: Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Deuschl
authors.affiliation: Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Binder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D020766:Intracranial Embolism / Q000628:therapy*; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents