title: Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis.
abstract: BACKGROUND
  No randomized trial has investigated the effect of mechanical thrombectomy (MT) alone in patients with acute stroke. There are conflicting results as to whether prior intravenous thrombolysis (IVT) facilitates subsequent MT, and data in patients treated with MT alone owing to contraindications to IVT are limited.
  
  
  OBJECTIVE
  To compare consecutive patients treated with MT alone or with preceding IVT in a large tertiary neurointerventional center, with special emphasis on contraindications to IVT.
  
  
  METHODS
  Retrospective analysis of 283 consecutive patients with acute ischemic stroke treated with MT in a tertiary neurovascular center over 14 months. Data on characteristics of periprocedural times, recanalization rate, complications, and long-term functional outcome were collected prospectively.
  
  
  RESULTS
  Information on prior IVT and functional outcome was available in 250 patients. Mean (SD) follow-up period was 5.7 (5.1) months and 105 (42%) patients received both IVT and MT. No significant differences were found in successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) 2b/3, 73.8% vs 73.1, p=0.952), complication rates, and long-term favorable outcome (modified Rankin Scale 0-2, 35.2% vs 40%, p=0.444) between patients receiving MT plus IVT and those receiving MT alone. A favorable outcome in patients directly treated with MT alone who were eligible for IVT was achieved in 48.2%. Thrombectomy was safe and resulted in a favorable outcome in 32% of patients with absolute contraindications to IVT.
  
  
  CONCLUSIONS
  Preceding use of IVT was not an independent predictor of favorable outcome in patients with acute stroke treated with MT and complication rates did not differ whether or not IVT was used. MT is safe and achieved a favorable outcome in one-third of patients with stroke ineligible for IVT.
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Weber
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Nordmeyer
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Jeffrie
authors.initials: J
authors.lastname: Hadisurya
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Heddier
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stauder
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Stracke
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Essen, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Chapot
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
keywords: Device; Stent; Stroke; Thrombectomy; Thrombolysis