Endovascular Thrombectomy With and Without Preceding Intravenous Thrombolysis for Treatment of Large Vessel Anterior Circulation Stroke: A Cross-Sectional Analysis of 50,000 Patients

Authors

Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla, NY 10595, United States of America.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Smit P. Shah, Department of Neurology, PRISMA Health - Midlands/University of South Carolina School of Medicine, Columbia, SC 29203, United States of America.
Vincent P. Galea, School of Medicine, New York Medical College, Valhalla, NY 10595, United States of America.
Jared B. Cooper, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Eric Feldstein, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Steven D. Shapiro, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Haris Kamal, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Christeena Kurian, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Gurmeen Kaur, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Rachana Tyagi, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Arundhati Biswas, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Jon Rosenberg, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Andrew Bauerschmidt, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Christian A. Bowers, Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87106, United States of America.
Stephan A. Mayer, Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America; Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, United States of America. Electronic address: fawaz.al-mufti@wmchealth.org.Follow

Author Type(s)

Faculty, Resident/Fellow

Journal Title

Journal of the Neurological Sciences

First Page

120168

Document Type

Article

Publication Date

3-15-2022

Department

Neurosurgery

Second Department

Neurology

Abstract

INTRODUCTION: The safety and efficacy of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) for large vessel occlusion stroke remains a highly contested and unanswered clinical question. We aim to characterize the clinical profile, complications, and discharge disposition of EVT patients treated with and without preceding IVT using a large, nationally-representative sample. METHODS: The National Inpatient Sample was queried from 2015 to 2018 to identify adult patients with anterior circulation stroke treated with EVT with and without preceding IVT. Multivariable logistic regression analysis and propensity-score matching were employed to assess adjusted associations with clinical endpoints and to address confounding by indication for IVT, respectively. RESULTS: Among 48,525 patients identified, 40.7% (n = 19,735) received IVT prior to EVT. On unadjusted analysis, patients treated with IVT bridging therapy experienced higher rates of intracranial hemorrhage (26% vs. 24%, p = 0.003) and routine discharge to home with or without services (33% vs. 27%, p < 0.001), a lower frequency of thromboembolic complications (3% vs. 5%, p < 0.001), and lower rates of extended hospital stays (eLOS) (20% vs. 24%, p < 0.001). Multivariable logistic regression analysis adjusting for demographic and baseline clinical characteristics demonstrated independent associations of IVT bridging therapy with intracranial hemorrhage (aOR 1.28, 95% CI 1.15, 1.43; p < 0.001), thromboembolic complications (aOR 0.66, 95% CI 0.53, 0.83; p < 0.001), routine discharge (aOR 1.27, 95% CI 1.15, 1.40; p < 0.001), and eLOS (aOR 0.76, 95% CI 0.68, 0.85; p < 0.001). Sensitivity testing confirmed these findings. CONCLUSION: Preceding IVT was associated with favorable functional outcomes following endovascular therapy. Prospective randomized clinical trials are warranted for further evaluation.

Recommended Citation

Dicpinigaitis, A. J., Gandhi, C. D., Shah, S. P., Galea, V. P., Cooper, J. B., Feldstein, E., Shapiro, S. D., Kamal, H., Kurian, C., Kaur, G., Tyagi, R., Biswas, A., Rosenberg, J., Bauerschmidt, A., Bowers, C. A., Mayer, S. A., & Al-Mufti, F. (2022). Endovascular Thrombectomy With and Without Preceding Intravenous Thrombolysis for Treatment of Large Vessel Anterior Circulation Stroke: A Cross-Sectional Analysis of 50,000 Patients. Journal of the Neurological Sciences, 434, 120168. https://doi.org/10.1016/j.jns.2022.120168