Start, Stop, Continue? The Benefit of Overlapping Intravenous Thrombolysis and Mechanical Thrombectomy

Objective Here we compare the procedural and clinical outcome of patients undergoing thrombectomy with running thrombolysis to matched controls with completed intravenous therapy and an only marginally overlapping activity. Methods Patients from 25 sites in Germany were included, who presented with an acute ischemic stroke. Patients' baseline characteristics (including ASPECTS, NIHSS and mRS), grade of reperfusion, and functional outcome 24â¯h and at day 90 after intervention were extracted from the German Stroke Registry (nâ¯= 2566). In a case-control design we stepwise matched the groups due to age, sex and time to groin puncture and time to flow restoration. Results In the initial cohort (overlap group nâ¯= 864, control group nâ¯= 1702) reperfusion status (median TICI in overlap group vs. control group: 3 vs. 2b), NIHSS after 24â¯h, early neurological improvement parameters, mRS at 24â¯h and at day 90 were significantly better in the overlap group (pâ¯< 0.001) with a similar risk of bleeding (2.9% vs. 2.4%) and death (18% vs. 22%). After adjustment mRS at day 90 still showed a trend for lower disability scores in the overlap group (3 IQR 1-5 vs. 3 IQR 1-6, pâ¯= 0.09). While comparable bleeding risk could be maintained (4% in both groups), there were significantly more deaths in the control group (18% vs. 30%, pâ¯= 0.006). Conclusion The presented results support the approach of continuing and completing a simultaneous administration of intravenous thrombolysis during mechanical thrombectomy procedures.