Assessment on effectiveness of intravenous thrombolysis in endovascular recanalization therapy : a retrospective cohort study

Abstract

Acute ischemic stroke (AIS) along with haemorrhagic stroke are the most debilitating cardiovascular events in need of rapid medical treatment . Until recent years primary treatment for acute ischemic stroke caused by large vessel occlusion (LVO) was medical management i.e. administration of intravenous thrombolysis. Currently it is under debate whether mechanical thrombectomy (MT) alone or MT combined with intravenous thrombolysis (IVT) provide best treatment results. This investigation assessed effectiveness of IVT combined with MT in recanalization results for ischemic stroke caused by anterior circulation LVO.

139 patient cases treated for anterior circulation ischemic stroke at Turku University Hospital in a two-year period were retrospectively evaluated by recanalization results and patient recovery outcome. The patient cases were divided into groups based on treatment received: MT only and IVT + MT -groups. All patient -cases acted as the control group. Statistical analysis included subdivision of groups by percentiles in each category under assessment. Margin for statistical significance was considered a minimum difference of 10% between the groups.

None of the categories under assessment exhibited the margin for statistical significance between the groups. Most substantial differences were obtained within the procedure time categories: > 180 min (9.0% lower for IVT + MT) and 61 – 180 min (5.8% lower for MT).

The investigation demonstrates similar results to other research conducted i.e. there exists no definite consensus on the non-inferiority of MT only treatment compared to the combination of IVT + MT when possible (no contraindications present). It is to be acknowledged that further conclusions require more profound statistical analyses as the research data was processed merely with percentile division and preferably consisting of a larger patient case cohort.