Stent Retriever Thrombectomy in Patients Who Are Ineligible for Intravenous Thrombolysis: A Multicenter Retrospective Observational Study.
OBJECTIVE
Intravenous thrombolysis with rtPA is the standard of care for patients with acute ischemic stroke within 4.5 hours after symptom onset. However, a considerable number of patients are ineligible for IV thrombolysis due to various contraindications. Recent studies have proved the superiority of mechanical thrombectomy for patients with large-vessel occlusions in combination with IV rtPA compared with IV rtPA alone. We aimed to demonstrate the efficacy of mechanical thrombectomy for patients who are ineligible for IV rtPA.


METHODS
Patients from the stroke registries of 4 dedicated centers who were treated with mechanical thrombectomy from January 2010 to October 2014 were retrospectively evaluated. Inclusion criteria were the following: acute stroke due to proved large-artery occlusion, ineligibility for IV thrombolysis, and a timeframe of ≤4.5 hours between stroke and the start of mechanical thrombectomy. Recanalization success, periprocedural complications, clinical outcome, and hemorrhages were evaluated.


RESULTS
One hundred thirty endovascular recanalization procedures were identified. The locations were the following: proximal ICA in 17 (13.1%), terminus ICA in 25 (19.2%), M1 segment in 77 (59.2%), and M2 segment in 11 (8.5%). TICI 2b/3 results were achieved in 101 (77.7%), and an mRS score of 0-2 in 47 patients (37.9%). There was a significant correlation between TICI 2b/3 results and good clinical outcomes (87.2% versus 6.8%; P = .048). A good clinical result was most frequent when recanalization was achieved within 4.5 hours (37/74 = 50% versus 10/50 = 20.0%; P = .001). Symptomatic hemorrhage occurred in 13.1% of patients; mortality was 24.2%. Periprocedural complications were recorded in 10 patients (7.7%).


CONCLUSIONS
Mechanical thrombectomy can achieve good clinical outcomes in patients with acute large-artery occlusion ineligible for IV thrombolysis, in particular when recanalization is reached early.
From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.) Departments of Neuroradiology (F.D., M.P., H.B., G.F.) franziska.dorn@med.uni-muenchen.de.
F
http://orcid.org/0000-0002-9287-9512
F
Dorn
Departments of Neuroradiology (S.P., C.Z.).
S
http://orcid.org/0000-0002-3964-3885
S
Prothmann
Departments of Neuroradiology (F.D., M.P., H.B., G.F.).
M
http://orcid.org/0000-0003-0465-6923
M
Patzig
From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.).
H
http://orcid.org/0000-0002-3610-3074
H
Lockau
From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.).
C
http://orcid.org/0000-0003-3712-2258
C
Kabbasch
Departments of Neuroradiology (O.N., M.W.).
O
http://orcid.org/0000-0002-2055-4217
O
Nikoubashman
From the Departments of Neuroradiology and Radiology (F.D., H.L., C.K., T.L.).
T
http://orcid.org/0000-0001-5640-7780
T
Liebig
Departments of Neuroradiology (S.P., C.Z.).
C
http://orcid.org/0000-0002-4805-9103
C
Zimmer
Departments of Neuroradiology (F.D., M.P., H.B., G.F.).
H
http://orcid.org/0000-0001-8034-4345
H
Brückmann
Departments of Neuroradiology (O.N., M.W.).
M
http://orcid.org/0000-0002-8261-5513
M
Wiesmann
Neurology (H.S.), University Hospital of Cologne, Cologne, Germany.
H
http://orcid.org/0000-0002-8853-2145
H
Stetefeld
Neurology (H.P.), Klinikum Rechts der Isar, Technical University, Munich, Germany.
H
http://orcid.org/0000-0003-2189-7681
H
Poppert
Neurology (A.R.), University Hospital of Aachen, Aachen, Germany.
A
http://orcid.org/0000-0002-9439-7963
A
Reich
Neurology (L.K.), University Hospital of Munich, Munich, Germany.
L
http://orcid.org/0000-0002-4967-8336
L
Kellert
Departments of Neuroradiology (F.D., M.P., H.B., G.F.).
G
http://orcid.org/0000-0002-6357-6694
G
Fesl
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome