Abstract Details

Title Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Background MT has demonstrated a safe and effective profile for treating TL. However, alternative endovascular approaches to optimize outcomes are currently under investigation. The role of IVT preceding MT is not fully defined.

Objective To describe the safety and efficacy of mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for patients with tandem lesions (TL). In addition, we assessed if the use of intraprocedural antiplatelets (APTs) influenced the safety of MT with IVT treatment.

Design/Methods We performed a sub-analysis of an international registry of 16 centers. Patients were divided into MT only versus IVT+MT groups. Primary outcomes were sICH, parenchymal hematoma type 2 (PH2), and hemorrhagic transformation. Additional outcomes were successful (mTICI2b-3) and complete reperfusion (mTICI3), 90-day mRS 0-2, 90-day mRS 0-1, in-hospital and 90-day mortality. Multivariable logistic and nominal regressions were used to assess the association between both groups.

Results

Of 691 patients, 599 were included (255 underwent IVT+MT and 344 MT only). After adjusting for confounders there was no difference in the risk of sICH (aOR=1.43;95%CI 0.72–2.87;p=0.308), PH2 (aOR=1.14;95%CI 0.57–2.28;p=0.705), and hemorrhagic transformation (aOR=0.92;95%CI 0.54–1.57;p=0.751) between groups. There was an IVT-by-intraprocedural APTs interaction (p_interaction=0.031). IVT increased the risk of sICH in patients with IV-APT therapy (aOR=3.58;95%CI 1.17–10.89;p=0.025). The IVT+MT group had higher odds of 90-day mRS 0-2 in patients within the 6 hours window (aOR=1.83;95%CI 1.02–3.27;p=0.042). The odds of successful reperfusion, complete reperfusion, 90-days mRS 0-1, in-hospital mortality, or 90-days mortality were not different between groups.

Conclusions

Our study showed that the combination of IVT+MT for TL did not increase the risk of sICH, PH2, nor hemorrhagic transformation in comparison with MT only. Treatment with IVT with MT was associated with a higher rate of favorable functional outcome at 90 days within the 6-hour window. The use of IVT before MT increased the risk of sICH in patients who received intraprocedural IV-APTs.

Authors/Disclosures
Aaron E. Rodriguez-Calienes (University of Iowa Hospitals and Clinics) PRESENTER	Dr. Rodriguez-Calienes has nothing to disclose.
Milagros Galecio-Castillo, MD (University of Iowa Hospitals and Clinics)	Dr. Galecio-Castillo has nothing to disclose.
Mudassir Farooqui, MD	Dr. Farooqui has nothing to disclose.
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.
Albert Yoo (Texas Stroke Institute)	No disclosure on file
Afshin A. Divani, PhD (University of New Mexico)	The institution of Dr. Divani has received research support from Department of Defense.
Nils Petersen, MD (Yale University)	Dr. Petersen has received research support from NIH.
Michael G. Abraham, MD (The University of Kansas Health System)	Dr. Abraham has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker Neurovascular.
Johanna T. Fifi, MD, FAAN (Mount Sinai Hospital)	Dr. Fifi has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Stryker, Inc. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Fifi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Serenity. Dr. Fifi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MIVI. Dr. Fifi has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Fifi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. Dr. Fifi has stock in Endostream. Dr. Fifi has stock in Synchron. Dr. Fifi has stock in Imperative Care. Dr. Fifi has stock in Truvic. Dr. Fifi has stock in Bendit. Dr. Fifi has stock in Cerebrotech. Dr. Fifi has stock in Sim&Cure. Dr. Fifi has stock in Q'Apel. The institution of Dr. Fifi has received research support from Viz AI.
Waldo Guerrero, MD (University of South Florida College of Medicine)	Dr. Guerrero has nothing to disclose.
Amer Malik, MD (University of Miami Miller School of Medicine)	Dr. Malik has nothing to disclose.
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various medicolegal cases. The institution of Dr. Siegler has received research support from Viz.ai.
Thanh Nguyen, MD	Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Guillermo Linares, MD	Dr. Linares has nothing to disclose.
Nazli A. Janjua, MD, MBBS	Dr. Janjua has nothing to disclose.
Darko E. Quispe Orozco, MD (TTUHSC-SOM, Lubbock; Neurology Dept.)	Dr. Quispe Orozco has nothing to disclose.
Syed F. Zaidi, MD (ProMedica Stroke Network)	Dr. Zaidi has nothing to disclose.
Jessica Kobsa (Yale University)	Ms. Kobsa has nothing to disclose.
Ayush Prasad (Yale School of Medicine & Yale - New Haven Hospital)	Mr. Prasad has nothing to disclose.
Asad Ikram, MD, MBBS (Tarrant Neurology Consultants P.A.)	Dr. Ikram has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Abid Qureshi, MD (University of Kansas Medical Center)	Dr. Qureshi has nothing to disclose.
Tiffany Barkley, DO (University of Kansas)	Dr. Barkley has nothing to disclose.
Stavros Matsoukas	No disclosure on file
Mohamad Abdalkader (Boston Medical Center Deptartment Of Radiology)	Mohamad Abdalkader has nothing to disclose.
Sergio A. Marioni	No disclosure on file
Jazba Soomro, MD (Texas Stroke Institute)	Dr. Soomro has nothing to disclose.
Juan A. Vivanco-Suarez, MD	Mr. Vivanco-Suarez has nothing to disclose.
Randall Edgell, MD	Dr. Edgell has nothing to disclose.
Maxim Mokin, MD, PhD (University of South Florida)	Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Mokin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Mokin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Mokin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Foley Mansfield.
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.
Mouhammad A. Jumaa, MD (ProMedica Stroke Network)	Dr. Jumaa has nothing to disclose.
Ameer Hassan, DO (Valley Baptist Medical Center)	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.