Abstract Details

Title Post-Thrombectomy Outcome is Not Associated with Administration of Intravenous Thrombolysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-009

Background

There is conflicting data about the relationship between administration of intravenous thrombolysis prior to thrombectomy and outcome.

Objective

To evaluate whether administration of intravenous thrombolysis prior to thrombectomy for acute ischemic stroke is associated with outcome.

Design/Methods

We retrospectively identified all acute ischemic stroke patients who underwent mechanical thrombectomy at two large, urban, academic centers between December 2018 and November 2020. We compared outcomes in patients treated with intravenous tissue plasminogen activator (tPA) + thrombectomy to patients who only underwent thrombectomy.

Results

Of 254 patients, 80 (31%) were given intravenous tPA prior to thrombectomy. Patients who were given tPA had shorter time from LSW to stroke code activation (113 minutes (IQR 51-202) vs. 372 minutes (138-777), p<0.001), but there was no difference in initial NIHSS (18 (IQR 12-22) vs. 17 (IQR 9-25)), ASPECT scores (9 (IQR 8-10) vs. 9 (IQR 8-10)), or score of TICI 3 (58% vs. 55%) between groups. There was no significant difference in the following outcomes in patients treated with tPA+thrombectomy vs. thrombectomy: 48-hour ASPECT score (7 (IQR 5-9) vs. 8 (IQR 6-9)), discharge NIHSS score (5 (IQR 1-13) vs. 6 (IQR 2-12.5)), change in NIHSS score (10 (IQR 2-15) vs. 6 (IQR 1-12)), symptomatic hemorrhage (17% vs. 10%), discharge mortality (16% vs. 17%), or mRS score at 3-months (3 (IQR 1-6) vs. 3 (IQR 2-6)).

Conclusions

Outcomes after acute ischemic stroke did not differ between patients treated with intravenous tPA+thrombectomy compared to patients who underwent thrombectomy in our cohort. Further investigation is needed to determine which patients may benefit from intravenous thrombolysis prior to thrombectomy.

Authors/Disclosures
Amanda Zhao, MD (NYU Langone Hospital) PRESENTER	Ms. Zhao has nothing to disclose.
Penina Krieger, MD (Penina Krieger)	Ms. Krieger has nothing to disclose.
Leah Croll, MD (NYU Langone Dept of Neurology)	Dr. Croll has nothing to disclose.
Hannah Irvine, MD (NYU Langone Medical Center)	Dr. Irvine has nothing to disclose.
Jose L. Torres, MD (NYU)	Dr. Torres has nothing to disclose.
Kara R. Melmed, MD	Dr. Melmed has nothing to disclose.
Aaron Lord, MD (NYU Langone-Brooklyn)	Dr. Lord has nothing to disclose.
Koto Ishida, MD, FAAN (NYU)	Dr. Ishida has received publishing royalties from a publication relating to health care.
Jennifer A. Frontera, MD (NYU Langone Health)	Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician Education Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.
Ariane Lewis, MD, FAAN (NYU Langone Medical Center)	Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.