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Effect of mechanical thrombectomy with and without intravenous thrombolysis on the functional outcome of patients with different degrees of thrombus perviousness

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

This study aimed to investigate the long-term functional outcome of patients with different degrees of thrombus perviousness (TP) undergoing mechanical thrombectomy alone and those undergoing combined intravenous thrombolysis (IVT) plus mechanical thrombectomy.

Methods

We conducted a retrospective analysis of consecutive patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy alone or bridging therapy between January 2016 and October 2020. TP was quantified by thrombus attenuation increase (TAI) on admission computed tomography angiography compared with non-contrast computed tomography. After dichotomization of TAI as higher or lower perviousness, Fisher exact tests were performed to estimate the associations of different therapies with favorable functional outcomes [Modified Ranking Scale score at 90 days (90-day mRS) of 0 to 2].

Results

A total of 73 patients were included in our study. 35 (47.9%) thrombi were classified as higher-perviousness clots with TAI of ≥ 24 HU, and the other 38 thrombi were lower-perviousness clots. A favorable outcome with a 90-day mRS of 0 to 2 was observed in 32 patients. In patients with thrombi of lower perviousness, favorable outcome was more common in the bridging therapy group than in the thrombectomy-alone group (p = 0.013), whereas in patients with thrombi of higher perviousness, the long-term neurological outcome did not significantly differ between two therapy groups (p = 0.094).

Conclusion

Patients with thrombi of lower perviousness were recommended to undergo intravenous alteplase followed by endovascular thrombectomy, and those with thrombi of higher perviousness could undergo thrombectomy alone.

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Abbreviations

EVT:

Endovascular treatment

CTA:

Computed tomography angiography

LVO:

Large vessel occlusion

TAI:

Thrombus attenuation increase

TP:

Thrombus perviousness

NCCT:

Non-contrast computed tomography

AIS:

Acute ischemic stroke

IVT:

Intravenous thrombolysis

MCA:

Middle cerebral artery

NIHSS:

National Institutes of Health Stroke Scale

mRS:

Modified Rankin Scale score

HU:

Hounsfield Unit

mTICI:

Thrombolysis In Cerebral Infarction

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Funding

This work is supported by grants from the National Key Research and Development Program of China (Grant No. 2019YFC0117703) and Shanghai Key Clinical Specialty (Grant No. shslczdzk03203).

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Author notes

  1. Kai Shang and Wangshu Zhu contributed equally to this work.

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200235, China

    Kai Shang, Wangshu Zhu, Lifang Ye & Yuehua Li

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  1. Kai Shang
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  2. Wangshu Zhu
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Correspondence to Yuehua Li.

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This is an observational study. The Shanghai Jiao Tong University Affiliated Sixth People’s Hospital Research Ethics Committee has confirmed that no ethical approval is required.

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Shang, K., Zhu, W., Ye, L. et al. Effect of mechanical thrombectomy with and without intravenous thrombolysis on the functional outcome of patients with different degrees of thrombus perviousness. Neuroradiology 65, 1657–1663 (2023). https://doi.org/10.1007/s00234-023-03210-0

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