Study Presented on Combining Intravenous Thrombolysis and Mechanical Thrombectomy for ELVO Stroke Patients

July 27, 2017—The Society of NeuroInterventional Surgery (SNIS) announced findings from study that suggest intravenous thrombolysis (IVT) pretreatment may improve mechanical thrombectomy (MT) outcomes in patients with emergent large vessel occlusions (ELVOs). The study, “Comparative Safety and Efficacy of Combined Intravenous Thrombolysis and Mechanical Thrombectomy with Mechanical Thrombectomy Alone in Emergent Large Vessel Occlusion,” was presented at the Society of NeuroInterventional Surgery (SNIS) 14th annual meeting held July 24–27 in Colorado Springs, Colorado.

SNIS noted that current top-tier guidelines already recommend IVT pretreatment for ELVO patients; however, this study uncovers specific benefits that can inform doctors and patients on the importance of the combined approach. This is the first study to examine if there are any differences in safety and efficacy outcomes in ELVO patients treated with combined IVT and MT versus MT alone.

The observational study collected data from six high-volume endovascular stroke centers over a 2-year period. A total of 292 patients underwent IVT and MT; 277 patients underwent MT monotherapy. After a propensity-matched analysis, patients in both groups were matched. At 3 months posttherapy, the combined therapy group did not differ significantly in terms of rates of successful recanalization and rates of symptomatic intracranial hemorrhage. However, the combined group tended to have higher rates of functional improvement (47% vs 37%) and lower rates of mortality (18% vs 29%). IVT pretreatment was independently associated with beneficial outcomes based on the matched subgroups of patients.

Muhammad Ishfaq, MD, lead author of the study, commented in the SNIS announcement, “The medical field is becoming more aware of the benefits of mechanical thrombectomy for ELVO strokes, and these new findings related to IVT pretreatment could lead to more positive health outcomes for patients, which is the ultimate goal of our work.” Dr. Ishfaq is a resident physician at the University of Tennessee Health Science Center in Memphis, Tennessee.