Mechanical thrombectomy versus systemic thrombolysis in MCA stroke: a distance to thrombus-based outcome analysis.
BACKGROUND
Acute ischemic stroke due to occlusion of the middle cerebral artery (MCA) has a poor outcome. The distance to thrombus (DT) from the carotid T can predict the outcome after intravenous thrombolysis (IVT). With a DT <16 mm, fewer than 50% of patients treated with IVT have a favorable outcome.


OBJECTIVE
To compare stent retriever-based endovascular mechanical thrombectomy (MT) plus additional IVT (IVT-MT) with IVT alone.


METHODS
Patients with MCA occlusion proved by CT angiography with a DT <16 mm, treated with either IVT alone or with stent retriever-based endovascular IVT-MT, were included in this study. Changes in National Institutes of Health Stroke Scale (NIHSS), the 7-day NIHSS, and the 90-day modified Rankin Scale (mRS) scores were analyzed by treatment modality.


RESULTS
Of 621 patients, 87 fulfilled all inclusion criteria. Fifty-nine patients were treated with IVT and 28 with IVT-MT. Although patients treated with IVT-MT had had significantly more severe strokes than those treated with IVT alone (initial NIHSS 16 (7-18) vs 14 (5-22); p=0.032), both the short- and long-term outcomes were significantly better in this patient group (NIHSS improvement on day 7: 10.9±6.3 vs 6.7±6.7; p=0.008/90-day mRS: 2 (0.75-2.5) vs 4 (2-6); p=0.003).


CONCLUSIONS
In patients with an acute MCA occlusion and a DT <16 mm, IVT-MT leads to a significantly better outcome than in patients treated with IVT alone.
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Donald
D
Lobsien
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Matthias
M
Gawlitza
Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
Alexander
A
Schaudinn
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Stefan
S
Schob
Department of Neurology, University Hospital Leipzig, Leipzig, Germany.
Carsten
C
Hobohm
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Dominik
D
Fritzsch
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Ulf
U
Quäschling
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Karl-Titus
KT
Hoffmann
Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.
Benjamin
B
Friedrich
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy*; D007262:Infusions, Intravenous; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator
Angiography; CT Angiography; Intervention; Stroke; Thrombectomy