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Stroke thrombolysis and thrombectomy—not stronger together?

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Two studies have shown no added benefit of intravenous thrombolysis in patients with acute stroke who are treated with mechanical thrombectomy. We review the importance and interpretation of these findings, compare them to the current guidelines on stroke thrombectomy, and discuss how these studies can change our daily clinical practice.

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References

  1. Powers, W. J. et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 46, 3020–3035 (2015).

    Article  CAS  Google Scholar 

  2. Wahlgren, N. et al. Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int. J. Stroke 11, 134–147 (2016).

    Article  Google Scholar 

  3. Abilleira, S. et al. Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different. Stroke 48, 375–378 (2017).

    Article  Google Scholar 

  4. Coutinho, J. M. et al. Combined intravenous thrombolysis and thrombectomy versus thrombectomy alone for acute ischemic stroke: a pooled analysis of the SWIFT and STAR studies. JAMA Neurol. http://dx.doi.org/10.1001/jamaneurol.2016.5374 (2017).

  5. Goyal, M. et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387, 1723–1731 (2016).

    Article  Google Scholar 

  6. Broeg-Morvay, A. et al. Direct mechanical intervention versus combined intravenous and mechanical intervention in large artery anterior circulation stroke: a matched-pairs analysis. Stroke 47, 1037–1044 (2016).

    Article  Google Scholar 

  7. Weber, R. et al. Comparison of outcome and interventional complication rate in patients with acute stroke treated with mechanical thrombectomy with and without bridging thrombolysis. J. Neurointerv. Surg. http://dx.doi.org/10.1136/neurintsurg-2015-012236 (2016).

  8. Menon, B. K. et al. Analysis of workflow and time to treatment on thrombectomy outcome in the endovascular treatment for small core and proximal occlusion ischemic stroke (ESCAPE) randomized, controlled trial. Circulation 133, 2279–2286 (2016).

    Article  CAS  Google Scholar 

  9. Sheth, K. N. et al. Drip and ship thrombolytic therapy for acute ischemic stroke: use, temporal trends, and outcomes. Stroke 46, 732–739 (2015).

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Elad I. Levy is in the Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Suite B4, Buffalo, New York 14203, USA.,

    Elad I. Levy

  2. Maxim Mokin is in the Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, 2 Tampa General Circle, Tampa, Florida 33606, USA.,

    Maxim Mokin

Authors
  1. Elad I. Levy
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Correspondence to Elad I. Levy.

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Competing interests

E.I.L. has shareholder/ownership interests in Blockade Medical, Intratech Medical and NeXtGen Biologics. He serves as a national principal investigator for the Covidien US SWIFT PRIME Trials and receives honoraria for training and lecturing from Covidien. He receives compensation from Abbott for carotid training sessions for physicians. He serves as a consultant to Pulsar and Blockade Medical and on the Acute Ischemic Stroke Clinical Advisory Board for Stryker and the Advisory Board for NeXtGen Biologics and MEDX. M.M. declares no competing interests.

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Levy, E., Mokin, M. Stroke thrombolysis and thrombectomy—not stronger together?. Nat Rev Neurol 13, 198–200 (2017). https://doi.org/10.1038/nrneurol.2017.22

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