Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy

Hong Kyun Park, Jong Won Chung, Jeong Ho Hong, Min Uk Jang, Hyun Du Noh, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Moon Ku Han, Beom Joon Kim, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Jun Lee, Keun Sik HongYong Jin Cho, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Ki Hyun Cho, Joon Tae Kim, Dong Eog Kim, Wi Sun Ryu, Jay Chol Choi, Wook Joo Kim, Dong Ick Shin, Min Ju Yeo, Sung Il Sohn, Ji Sung Lee, Juneyoung Lee, Byung Woo Yoon, Hee Joon Bae

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)51-58
Number of pages8
JournalCerebrovascular Diseases
Volume44
Issue number1-2
DOIs
Publication statusPublished - 2017 Jul 1

Keywords

  • Acute ischemic stroke
  • Acute stroke therapy
  • Comparative effectiveness research
  • Endovascular therapy
  • Functional outcome
  • Preceding intravenous thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy'. Together they form a unique fingerprint.

  • Cite this

    Park, H. K., Chung, J. W., Hong, J. H., Jang, M. U., Noh, H. D., Park, J. M., Kang, K., Lee, S. J., Ko, Y., Kim, J. G., Cha, J. K., Kim, D. H., Nah, H. W., Han, M. K., Kim, B. J., Park, T. H., Park, S. S., Lee, K. B., Lee, J., ... Bae, H. J. (2017). Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy. Cerebrovascular Diseases, 44(1-2), 51-58. https://doi.org/10.1159/000471492