Early Endovascular Treatment in Intravenous Tissue Plasminogen Activator–Ineligible Patients

BACKGROUND AND PURPOSE—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 col...

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Published in:Stroke (1970) 2016-04, Vol.47 (4), p.1131-1134
Main Authors: Rebello, Letícia C, Haussen, Diogo C, Grossberg, Jonathan A, Belagaje, Samir, Lima, Andrey, Anderson, Aaron, Frankel, Michael R, Nogueira, Raul G
Format: Article
Language:English
Subjects:
Aged
Brain Ischemia - therapy
Endovascular Procedures - adverse effects
Female
Fibrinolytic Agents - therapeutic use
Humans
Male
Middle Aged
Retrospective Studies
Stroke - therapy
Time Factors
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
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Summary:BACKGROUND AND PURPOSE—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
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.115.012586