title: Intravenous Thrombolysis Facilitates Successful Recanalization with Stent-Retriever Mechanical Thrombectomy in Middle Cerebral Artery Occlusions.
abstract: OBJECTIVE
  Several factors influence the outcome after acute ischemic stroke secondary to proximal occlusions of cerebral vessels. Among others, noneligibility for intravenous thrombolysis (IVT) and incomplete revascularization have been identified as predictors of unfavorable outcome. The aim of this study was to investigate whether concomitant IVT influences the revascularization efficacy in mechanical thrombectomy (MT).
  
  
  METHODS
  This study conducted a retrospective analysis of all consecutive patients presenting with an anterior circulation stroke due to large-artery occlusion with imaging evidence who were treated with MT between July 2012 and December 2013 at 2 high-volume stroke centers. Imaging data were regraded and re-evaluated according to the modified Treatment in Cerebral Ischemia scale and its respective vessel occlusion site definitions. Clinical end points included National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale; imaging and procedural measures were technical end points.
  
  
  RESULTS
  We identified 93 patients who presented with an occlusion of the middle cerebral artery (MCA): of these patients, 66 (71%) received IVT. We did not find statistically significant differences in the baseline NIHSS score, time from symptom onset to groin puncture, and age when comparing the IVT group with the non-IVT group. The rate of successful recanalizations (modified Treatment in Cerebral Ischemia score ≥ 2b) was significantly higher in patients with MCA occlusion and concomitant IVT (P = .01). Stepwise logistic regression identified IVT and thrombus length as predictive factors for successful mechanical recanalization (P = .004, P = .002).
  
  
  CONCLUSIONS
  IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion.
authors: Department of Neuroradiology, University Medical Center, Georg-August-University Göttingen, Göttingen, Germany. Electronic address: daniel.behme@med.uni-goettingen.de.
authors: Daniel
authors: D
authors: Behme
authors: Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany.
authors: Christoph
authors: C
authors: Kabbasch
authors: Department of Radiology and Neuroradiology, Ruhr University Bochum, Bochum, Germany.
authors: Annika
authors: A
authors: Kowoll
authors: Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany.
authors: Franziska
authors: F
authors: Dorn
authors: Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany.
authors: Thomas
authors: T
authors: Liebig
authors: Department of Radiology and Neuroradiology, Ruhr University Bochum, Bochum, Germany.
authors: Werner
authors: W
authors: Weber
authors: Department of Radiology and Neuroradiology, University of Cologne, Cologne, Germany. Electronic address: anastasios.mpotsaris@uk-koeln.de.
authors: Anastasios
authors: A
authors: Mpotsaris
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; endovascular therapy; intravenous thrombolysis; mechanical thrombectomy; recanalization; stent retriever