title: Early Endovascular Treatment in Intravenous Tissue Plasminogen Activator-Ineligible Patients.
abstract: OBJECTIVE
  Intravenous tissue-type plasminogen activator (tPA) treatment in acute stroke has many exclusion criteria. We aimed to assess the safety and efficacy of endovascular therapy (ET) in intravenous (IV) tPA-ineligible patients.
  
  
  METHODS
  Retrospective analysis of a prospectively collected database of consecutive patients treated with ET within 6 hours of stroke onset between September 2010 and April 2015. Patients treated with IV-tPA followed by ET were compared with those treated with ET alone because of IV-tPA ineligibility. Efficacy and safety end points included the rates of good outcome (90-day modified Rankin scale score ≤2), successful reperfusion (modified Treatment in Cerebral Ischemia 2b-3), parenchymal hematoma (PH-1 and PH-2), and 90-day mortality. Univariate and logistic regression were performed to identify the predictors of outcomes.
  
  
  RESULTS
  A total of 422 patients were included. Two hundred and fifty-three (59%) patients received IV-tPA+ET, and 169 (41%), ET alone. Combined IV-tPA+ET patients were slightly younger (64.9±15.2 versus 67.9±14.9 years; P=0.05), more often males (56% versus 44%; P=0.01), and had less hypertension (70% versus 81%; P=0.02) and vertebrobasilar occlusions (3% versus 8%; P=0.02). The remaining baseline characteristics, including National Institutes of Health Stroke Scale score (20 [15-23] versus 19 [15-24]; P=0.85), Alberta Stroke Program Early CT Score (ASPECTS; 8 [7-9] versus 8 [7-9]; P=0.24), and stroke onset to puncture times (235±70 versus 240±81 minutes; P=0.27), were similar across both groups. There were no significant differences in the rates of modified Treatment in Cerebral Ischemia 2b-3 (83% versus 80%; P=0.52), 90-day modified Rankin scale score ≤2 (45% versus 38%; P=0.21), or any PH (3% versus 5%; P=0.21). Unadjusted 90-day mortality was higher with ET alone (21% versus 34%; P<0.01); however, IV-tPA ineligibility was not associated with modified Treatment in Cerebral Ischemia 2b-3, any PH, good outcome, or 90-day mortality on logistic regression.
  
  
  CONCLUSIONS
  IV-tPA-eligible and -ineligible patients seem to have similar outcomes after early ET.
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Letícia C
authors.initials: LC
authors.lastname: Rebello
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Grossberg
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Samir
authors.initials: S
authors.lastname: Belagaje
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Andrey
authors.initials: A
authors.lastname: Lima
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Anderson
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA. raul.g.nogueira@emory.edu.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: endovascular treatment; reperfusion; stroke; tissue-type plasminogen activator