Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy
- Authors
- Park, Hong-Kyun; Chung, Jong-Won; Hong, Jeong-Ho; Jang, Min Uk; Noh, Hyun-Du; Park, Jong-Moo; Kang, Kyusik; Lee, Soo Joo; Ko, Youngchai; Kim, Jae Guk; Cha, Jae-Kwan; Kim, Dae-Hyun; Nah, Hyun-Wook; Han, Moon-Ku; Kim, Beom Joon; Park, Tai Hwan; Park, Sang-Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Byung-Chul; Yu, Kyung-Ho; Oh, Mi-Sun; Cho, Ki-Hyun; Kim, Joon-Tae; Kim, Dong-Eog; Ryu, Wi-Sun; Choi, Jay Chol; Kim, Wook-Joo; Shin, Dong-Ick; Yeo, Min-Ju; Sohn, Sung Il; Lee, Ji Sung; Lee, Juneyoung; Yoon, Byung-Woo; Bae, Hee-Joon
- Issue Date
- 2017
- Publisher
- KARGER
- Keywords
- Preceding intravenous thrombolysis; Endovascular therapy; Functional outcome; Acute ischemic stroke; Comparative effectiveness research; Acute stroke therapy
- Citation
- CEREBROVASCULAR DISEASES, v.44, no.1-2, pp.51 - 58
- Indexed
- SCIE
SCOPUS
- Journal Title
- CEREBROVASCULAR DISEASES
- Volume
- 44
- Number
- 1-2
- Start Page
- 51
- End Page
- 58
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/86286
- DOI
- 10.1159/000471492
- ISSN
- 1015-9770
- Abstract
- Background: The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. Methods: From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios (ORs) of preceding IVT. Results: Of the 639 patients (male, 61%; age 69 +/- 12; National Institutes of Health Stroke Scale score of 15 [11-19]) who met the eligibility criteria, 458 received preceding IVT. These patients showed lower mRS scores (adjusted common OR, 1.38 [95% CI 0.98-1.96]). Preceding IVT was associated with successful recanalization (1.96 [1.23-3.11]) and reduced 3-month mortality (0.58 [0.35-0.97]) but not with SHT (0.96 [0.48-1.93]). Conclusion: In patients treated with EVT within 8 of acute ischemic stroke onset, preceding IVT may enhance survival and successful recanalization without additional risk of SHT, and mitigate disability at 3 months. (C) 2017 S. Karger AG, Basel
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