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Clinical and Translational Neuroscience is published by MDPI from Volume 5 Issue 2 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with SAGE.
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Article

Earlier IV Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke Are Associated with a Better Recanalization

by
Nicolas Nicastro
1,2,*,
Antoine F Eger
3,
Iman I Boukrid
3,
Hubertus FG Mueller
4,
Paolo Machi
5,
Maria Isabel Vargas
5,
Pierre-Alexandre Poletti
6,
Alexandra Platon
6 and
Roman F Sztajzel
4
1
Department of Psychiatry, University of Cambridge, Hills Road, Cambridge CB2 0SP, UK
2
Division of Neurorehabilitation, Geneva University Hospitals, 1205 Geneva, Switzerland
3
Division of Neurology, Geneva University Hospitals, 1205 Geneva, Switzerland
4
Hôpital de la Tour, Meyrin, 1217 Geneva, Switzerland
5
Division of Neuroradiology, Geneva University Hospitals, 1205 Geneva, Switzerland
6
Department of Radiology, Geneva University Hospitals, 1205 Geneva, Switzerland
*
Author to whom correspondence should be addressed.
Clin. Transl. Neurosci. 2019, 3(1), 11; https://doi.org/10.1177/2514183x19855602
Submission received: 28 February 2019 / Accepted: 16 May 2019 / Published: 13 June 2019

Abstract

Introduction: Combined intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the recommended treatment options for acute ischemic stroke (AIS). It is unclear whether earlier IVT and MT management can predict complete vessel recanalization. Methods: In this single-center retrospective observational study, we included 81 consecutive subjects with proximal middle cerebral artery AIS (age 70.5 ± 14.2 years, 53% female) who had both IVT and MT. We assessed recanalization after mechanical procedure according to modified thrombolysis in cerebral infarction (TICI) score as well as the National Institute of Health Stroke Scale (NIHSS) score at 24 h. Outcomes were modified Rankin Scale (mRS) at discharge, mRS at 3 months, death at 3 months, and prevalence of intracerebral hemorrhage during hospitalization. Results: Multinomial logistic regression (χ2 = 49.4, p = 0.0075, pseudo-R2 = 0.26) showed that complete recanalization (TICI score = 3) was predicted by lower door-to-MT time (p = 0.014, 95% confidence interval (CI) = −0.09 to −0.01) and lower symptoms-to-IVT time (p = 0.045, 95% CI = −0.038 to −0.0004). An NIHSS score ≥ 10 at 24 h was predicted by higher baseline NIHSS (p < 0.0001) and lower TICI score (p = 0.009). Lower NIHSS at 24 h predicted a good outcome according to mRS at 3 months (p = 0.006). Similarly, higher NIHSS at 24 h was a predictor of death at 3 months (p = 0.013). Conclusions: The present study suggests that bridging therapy may improve vascular recanalization when both IVT and MT are performed earlier.
Keywords: acute ischemic stroke; intravenous thrombolysis; mechanical thrombectomy; outcome acute ischemic stroke; intravenous thrombolysis; mechanical thrombectomy; outcome

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MDPI and ACS Style

Nicastro, N.; Eger, A.F.; Boukrid, I.I.; Mueller, H.F.; Machi, P.; Vargas, M.I.; Poletti, P.-A.; Platon, A.; Sztajzel, R.F. Earlier IV Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke Are Associated with a Better Recanalization. Clin. Transl. Neurosci. 2019, 3, 11. https://doi.org/10.1177/2514183x19855602

AMA Style

Nicastro N, Eger AF, Boukrid II, Mueller HF, Machi P, Vargas MI, Poletti P-A, Platon A, Sztajzel RF. Earlier IV Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke Are Associated with a Better Recanalization. Clinical and Translational Neuroscience. 2019; 3(1):11. https://doi.org/10.1177/2514183x19855602

Chicago/Turabian Style

Nicastro, Nicolas, Antoine F Eger, Iman I Boukrid, Hubertus FG Mueller, Paolo Machi, Maria Isabel Vargas, Pierre-Alexandre Poletti, Alexandra Platon, and Roman F Sztajzel. 2019. "Earlier IV Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke Are Associated with a Better Recanalization" Clinical and Translational Neuroscience 3, no. 1: 11. https://doi.org/10.1177/2514183x19855602

APA Style

Nicastro, N., Eger, A. F., Boukrid, I. I., Mueller, H. F., Machi, P., Vargas, M. I., Poletti, P. -A., Platon, A., & Sztajzel, R. F. (2019). Earlier IV Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke Are Associated with a Better Recanalization. Clinical and Translational Neuroscience, 3(1), 11. https://doi.org/10.1177/2514183x19855602

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