Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry.

Agathe Le Floch, Frédéric Clarençon, Aymeric Rouchaud, Maeva Kyheng, Julien Labreuche, Igor Sibon, Gregoire Boulouis, Benjamin Gory, Sébastien Richard, Jildaz Caroff, Raphaël Blanc, Pierre Seners, Omer F Eker, Tae-Hee Cho, Arturo Consoli, Romain Bourcier, benoit guillon, Cyril Dargazanli, Caroline Arquizan, Christian Denier, Francois Eugene, Stephane Vannier, Jean-Christophe Gentric, Maxime Gauberti, Olivier Naggara, Charlotte Rosso, Guillaume Turc, Ozlem Ozkul-Wermester, Christophe Cognard, Jean François Albucher, Serge Timsit, Frederic Bourdain, Anthony Le Bras, Sebastian Richter, Solène Moulin, Raoul Pop, Olivier Heck, Ricardo Moreno, Vincent L'Allinec, Bertrand Lapergue, Gaultier Marnat
J NeuroIntervent Surg. 2022-12-02; 15(e2): e289-e297
DOI: 10.1136/jnis-2022-019672

Lire sur PubMed

BackgroundIntravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone.MethodsWe conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0–2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients.ResultsAmong 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004).ConclusionsIn cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.

Auteurs Bordeaux Neurocampus