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Acta Neurologica Belgica

, Volume 118, Issue 1, pp 105–111 | Cite as

Relevance of standard intravenous thrombolysis in endovascular stroke therapy of a tertiary stroke center

  • Annette Heinrichs
  • Omid Nikoubashman
  • Kolja Schürmann
  • Simone C. Tauber
  • Martin Wiesmann
  • Jörg B. Schulz
  • Arno Reich
Original Article

Abstract

The majority of patients undergoing endovascular stroke treatment (EST) in randomized controlled trials received additional systemic thrombolysis (“combination or bridging therapy (C/BT)”). Nevertheless, its usefulness in this subtype of acute ischemic stroke (AIS) is discussed controversially. Of all consecutive AIS patients, who received any kind of reperfusion therapy in a tertiary university stroke center between January 2015 and March 2016, those with large vessel occlusions (LVO) and EST with or without additional C/BT, were compared primarily regarding procedural aspects. Data were extracted from an investigator-initiated, single-center, prospective and blinded end-point study. 70 AIS patients with EST alone and 118 with C/BT were identified. Significant baseline differences existed in pre-existing cardiovascular disease (52.9% (EST alone) vs. 35.6% (C/BT), p = 0.023), use of anticoagulation (30.6% vs. 5.9%, p < 0.001), and frequency of unknown time of symptom onset (65.7% vs. 32.2%, p < 0.001), in-hospital stroke (18.6% vs. 1.7%, p < 0.001), pre-treatment ASPECT scores (7.9 vs. 8.9, p = 0.004), and frequency of occlusion in the posterior circulation (18.6% vs. 5.1%, p = 0.003). Pre-interventional procedural time intervals tended to be shorter in the C/BT group, reaching statistical significance in door-to-image time (30.3 (EST alone) vs. 22.2 min (C/BT), p < 0.001). Good clinical outcome (mRS d90) was reached more often in the C/BT group (24.5% vs. 11.8%, p = 0.064). Rates of symptomatic intracranial hemorrhages (sICH) were comparable (4.3% (EST alone) vs. 6.8% (C/BT), p = 0.481). Additional systemic thrombolysis did not delay EST. On the contrary, application of IVRTPA seemed to be a positive indicator for faster EST without increased side effects.

Keywords

Acute ischemic stroke Endovascular stroke therapy Systemic thrombolysis Combination or bridging therapy 

Abbreviations

IVRTPA

Intravenous recombinant tissue plasminogen activator

EST

Endovascular stroke therapy

C/BT

Combination or bridging therapy

AIS

Acute ischemic stroke

LVO

Large vessel occlusion

Notes

Acknowledgements

Prof. M. Wiesmann reports grants and personal fees from Stryker Neurovascular, grants and personal fees from SilkRoad Medical, grants from Covidien, grants from Microvention, grants and personal fees from Bracco, grants and personal fees from Siemens, grants from AB Medica, grants from Acandis, grants from Codman Neurovascular, grants from Penumbra, grants from Phenox, grants from Abbott, grants from St. Jude, from B. Braun, outside the submitted work.

Compliance with ethical standards

Conflict of interest

All other authors declare no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required for this type of study.

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Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  • Annette Heinrichs
    • 1
  • Omid Nikoubashman
    • 2
  • Kolja Schürmann
    • 1
  • Simone C. Tauber
    • 1
  • Martin Wiesmann
    • 2
  • Jörg B. Schulz
    • 1
    • 3
  • Arno Reich
    • 1
  1. 1.Department of NeurologyRWTH Aachen UniversityAachenGermany
  2. 2.Department of Diagnostic and Interventional NeuroradiologyRWTH Aachen UniversityAachenGermany
  3. 3.JARA-BRAIN Institute Molecular Neuroscience and NeuroimagingForschungszentrum Jülich GmbH and RWTH Aachen UniversityAachenGermany

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