Comparative Study

. 2024 Aug;312(2):e233041.

doi: 10.1148/radiol.233041.

Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion

Adam A Dmytriw^#¹, Sherief Ghozy^#¹, Hamza Adel Salim¹, Basel Musmar¹, James E Siegler¹, Hassan Kobeissi¹, Hamza Shaikh¹, Jane Khalife¹, Mohamad Abdalkader¹, Piers Klein¹, Thanh N Nguyen¹, Jeremy J Heit¹, Robert W Regenhardt¹, Nicole M Cancelliere¹, Kareem El Naamani¹, Abdelaziz Amllay¹, Lukas Meyer¹, Anne Dusart¹, Flavio Bellante¹, Géraud Forestier¹, Aymeric Rouchaud¹, Suzana Saleme¹, Charbel Mounayer¹, Jens Fiehler¹, Anna Luisa Kühn¹, Ajit S Puri¹, Christian Dyzmann¹, Peter T Kan¹, Marco Colasurdo¹, Gaultier Marnat¹, Jérôme Berge¹, Xavier Barreau¹, Igor Sibon¹, Simona Nedelcu¹, Nils Henninger¹, Thomas R Marotta¹, Christopher J Stapleton¹, James D Rabinov¹, Takahiro Ota¹, Shogo Dofuku¹, Leonard L L Yeo¹, Benjamin Y Q Tan¹, Juan Carlos Martinez-Gutierrez¹, Sergio Salazar-Marioni¹, Sunil Sheth¹, Leonardo Renieri¹, Carolina Capirossi¹, Ashkan Mowla¹, Nimer Adeeb¹, Hugo H Cuellar-Saenz¹, Stavropoula I Tjoumakaris¹, Pascal Jabbour¹, Priyank Khandelwal¹, Arundhati Biswas¹, Frédéric Clarençon¹, Mahmoud Elhorany¹, Kevin Premat¹, Iacopo Valente¹, Alessandro Pedicelli¹, João Pedro Filipe¹, Ricardo Varela¹, Miguel Quintero-Consuegra¹, Nestor R Gonzalez¹, Markus A Möhlenbruch¹, Jessica Jesser¹, Vincent Costalat¹, Adrien Ter Schiphorst¹, Vivek Yedavalli¹, Pablo Harker¹, Lina M Chervak¹, Yasmin Aziz¹, Benjamin Gory¹, Christian Paul Stracke¹, Constantin Hecker¹, Ramanathan Kadirvel¹, Monika Killer-Oberpfalzer¹, Christoph J Griessenauer¹, Ajith J Thomas¹, Cheng-Yang Hsieh¹, David S Liebeskind¹, Răzvan Alexandru Radu¹, Andrea M Alexandre¹, Illario Tancredi¹, Tobias D Faizy¹, Robert Fahed¹, Charlotte S Weyland¹, Boris Lubicz¹, Aman B Patel¹, Vitor Mendes Pereira¹, Adrien Guenego¹; MAD-MT Consortium¹

Affiliations

Affiliation

¹ From the Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, Mass (A.A.D., R.W.R., C.J.S., J.D.R., A.B.P.); Departments of Medical Imaging and Neurosurgery, Neurovascular Centre, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8 (A.A.D., N.M.C., T.R.M., V.M.P.); Departments of Neurologic Surgery & Radiology, Mayo Clinic, Rochester, Minn (S.G., H.K., R.K.); Cooper Neurologic Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ (J.E.S., H.S., J.K., A.J.T., A.G.); Departments of Radiology & Neurology, Boston Medical Center, Boston, Mass (M.A., P. Klein, T.N.N.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, Calif (J.J.H.); Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa (K.E.N., A.A., S.I.T., P.J.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, La (H.A.S., B.M., N.A., H.H.C.S.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.M., J.F. T.D.F.); Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.); Department of Neuroradiology, University Hospital of Limoges, Université de Limoges, Limoges, France (G.F., A.R., S. Saleme, C.M.); Department of Radiology, Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.L.K., A.S.P.); Department of Neuroradiology, Sana Kliniken, Lübeck GmbH, Lübeck, Germany (C.D.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.T.K., M.C.); Department of Interventional Neuroradiology, Bordeaux University Hospital, Bordeaux, France (G.M., J.B., X.B.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (I.S.); Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Mass (S.N., N.H.); Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Mass (N.H.); Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (N.H.); Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan (T.O., S.D.); Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Medicine, Division of Neurology, National University Hospital, Singapore (B.Y.Q.T.); Department of Neurology, UTHealth McGovern Medical School, Houston, Tex (J.C.M.G., S.S.M.); Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy (S. Sheth, L.R., C.C.); Department of Neurologic Surgery, Division of Stroke and Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif (A.M.); Department of Endovascular Neurosurgery and Neuroradiology, Rutgers University New Jersey Medical School in Newark, Newark, NJ (P. Khandelwal); Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY (A.B.); Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University, Paris, France (F.C., M.E., K.P.); Neurology Department, Faculty of Medicine, Tanta University, Egypt (M.E.); UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy (I.V., A.P., A.M.A.); Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal (J.P.F.); Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal (R.V.); Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, Calif (M.Q.C., N.R.G.); Department of Vascular and Interventional Neuroradiology, Universitätsklinikum Heidelberg, Heidelberg, Germany (M.A.M., J.J., C.W.); Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (V.C., R.A.R.); Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (A.t.S.); Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Md (V.Y.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio (P.H., L.M.C., Y.A.); Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France (B.G.); INSERM U1254, IADI, Université de Lorraine, Nancy, France (B.G.); Department of Radiology, Section of Interventional Neuroradiology, University Medical Center Münster, Münster, Germany (C.P.S.); Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria (C.H., M.K.O., C.J.G.); Department of Neurology, Sin-Lau Hospital, Tainan, Taiwan (C.Y.H.); UCLA Stroke Center and Department of Neurology Department, University of California Los Angeles, Los Angeles, Calif (D.S.L.); Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada (I.T., R.F.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (B.L.).

^# Contributed equally.

PMID: 39105645
PMCID: PMC11366672
DOI: 10.1148/radiol.233041

Comparative Study

Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion

Adam A Dmytriw et al. Radiology. 2024 Aug.

. 2024 Aug;312(2):e233041.

doi: 10.1148/radiol.233041.

Authors

Affiliation

¹ From the Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard University, Boston, Mass (A.A.D., R.W.R., C.J.S., J.D.R., A.B.P.); Departments of Medical Imaging and Neurosurgery, Neurovascular Centre, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8 (A.A.D., N.M.C., T.R.M., V.M.P.); Departments of Neurologic Surgery & Radiology, Mayo Clinic, Rochester, Minn (S.G., H.K., R.K.); Cooper Neurologic Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ (J.E.S., H.S., J.K., A.J.T., A.G.); Departments of Radiology & Neurology, Boston Medical Center, Boston, Mass (M.A., P. Klein, T.N.N.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, Calif (J.J.H.); Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa (K.E.N., A.A., S.I.T., P.J.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Shreveport, La (H.A.S., B.M., N.A., H.H.C.S.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.M., J.F. T.D.F.); Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.); Department of Neuroradiology, University Hospital of Limoges, Université de Limoges, Limoges, France (G.F., A.R., S. Saleme, C.M.); Department of Radiology, Division of Neurointerventional Radiology, University of Massachusetts Medical Center, Worcester, Mass (A.L.K., A.S.P.); Department of Neuroradiology, Sana Kliniken, Lübeck GmbH, Lübeck, Germany (C.D.); Department of Neurosurgery, University of Texas Medical Branch, Galveston, Tex (P.T.K., M.C.); Department of Interventional Neuroradiology, Bordeaux University Hospital, Bordeaux, France (G.M., J.B., X.B.); Department of Neurology, Bordeaux University Hospital, Bordeaux, France (I.S.); Department of Neurology, University of Massachusetts Chan Medical School, Worcester, Mass (S.N., N.H.); Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Mass (N.H.); Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (N.H.); Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan (T.O., S.D.); Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.L.Y., B.Y.Q.T.); Department of Medicine, Division of Neurology, National University Hospital, Singapore (B.Y.Q.T.); Department of Neurology, UTHealth McGovern Medical School, Houston, Tex (J.C.M.G., S.S.M.); Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy (S. Sheth, L.R., C.C.); Department of Neurologic Surgery, Division of Stroke and Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif (A.M.); Department of Endovascular Neurosurgery and Neuroradiology, Rutgers University New Jersey Medical School in Newark, Newark, NJ (P. Khandelwal); Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY (A.B.); Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast, Sorbonne University, Paris, France (F.C., M.E., K.P.); Neurology Department, Faculty of Medicine, Tanta University, Egypt (M.E.); UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy (I.V., A.P., A.M.A.); Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal (J.P.F.); Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal (R.V.); Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, Calif (M.Q.C., N.R.G.); Department of Vascular and Interventional Neuroradiology, Universitätsklinikum Heidelberg, Heidelberg, Germany (M.A.M., J.J., C.W.); Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (V.C., R.A.R.); Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France (A.t.S.); Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Md (V.Y.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, Ohio (P.H., L.M.C., Y.A.); Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France (B.G.); INSERM U1254, IADI, Université de Lorraine, Nancy, France (B.G.); Department of Radiology, Section of Interventional Neuroradiology, University Medical Center Münster, Münster, Germany (C.P.S.); Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria (C.H., M.K.O., C.J.G.); Department of Neurology, Sin-Lau Hospital, Tainan, Taiwan (C.Y.H.); UCLA Stroke Center and Department of Neurology Department, University of California Los Angeles, Los Angeles, Calif (D.S.L.); Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada (I.T., R.F.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (B.L.).

^# Contributed equally.

PMID: 39105645
PMCID: PMC11366672
DOI: 10.1148/radiol.233041

Abstract

Background The combination of intravenous thrombolysis (IVT) with mechanical thrombectomy (MT) may have clinical benefits for patients with medium vessel occlusion. Purpose To examine whether MT combined with IVT is associated with different outcomes than MT alone in patients with acute ischemic stroke (AIS) and medium vessel occlusion. Materials and Methods This retrospective study included consecutive adult patients with AIS and medium vessel occlusion treated with MT or MT with IVT at 37 academic centers in North America, Asia, and Europe. Data were collected from September 2017 to July 2021. Propensity score matching was performed to reduce confounding. Univariable and multivariable logistic regression analyses were performed to test the association between the addition of IVT treatment and different functional and safety outcomes. Results After propensity score matching, 670 patients (median age, 75 years [IQR, 64-82 years]; 356 female) were included in the analysis; 335 underwent MT alone and 335 underwent MT with IVT. Median onset to puncture (350 vs 210 minutes, P < .001) and onset to recanalization (397 vs 273 minutes, P < .001) times were higher in the MT group than the MT with IVT group, respectively. In the univariable regression analysis, the addition of IVT was associated with higher odds of a modified Rankin Scale (mRS) score 0-2 (odds ratio [OR], 1.44; 95% CI: 1.06, 1.96; P = .019); however, this association was not observed in the multivariable analysis (OR, 1.37; 95% CI: 0.99, 1.89; P = .054). In the multivariable analysis, the addition of IVT also showed no evidence of an association with the odds of first-pass effect (OR, 1.27; 95% CI: 0.9, 1.79; P = .17), Thrombolysis in Cerebral Infarction grades 2b-3 (OR, 1.64; 95% CI: 0.99, 2.73; P = .055), mRS scores 0-1 (OR, 1.27; 95% CI: 0.91, 1.76; P = .16), mortality (OR, 0.78; 95% CI: 0.49, 1.24; P = .29), or intracranial hemorrhage (OR, 1.25; 95% CI: 0.88, 1.76; P = .21). Conclusion Adjunctive IVT may not provide benefit to MT in patients with AIS caused by distal and medium vessel occlusion. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Wojak in this issue.

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Conflict of interest statement

Disclosures of conflicts of interest: A.A.D. No relevant relationships. S.G. No relevant relationships. H.A.S. No relevant relationships. B.M. No relevant relationships. J.E.S. Grants from National Institutes of Health (NIH; R61NS135583), Philips, Medtronic; consultant for AstraZeneca; honoraria for speaking at the American Academy of Neurology; compensation for medicolegal work; support for attending the American Academy of Neurology Annual Meeting and International Stroke Conference; board of directors for the Society of Vascular and Interventional Neurology; editorial board for Neurology and Stroke: Vascular and Interventional Neurology. H.K. No relevant relationships. H.S. No relevant relationships. J.K. No relevant relationships. M.A. No relevant relationships. P. Klein No relevant relationships. T.N.N. Advisory boards for TESLA, SELECT2, TATUM, CREST2, Idorsia, Brainomix; president of Society of Vascular and Interventional Neurology; associate editor for Stroke. J.J.H. Grants or contracts from NIH; consulting fees from Medtronic, MicroVention, Balt, iSchemaView; advisory board for Balt, MicroVention, iSchemaView; board of directors for Society Neurointerventional Surgery. R.W.R. Research grants from NIH, Society of Vascular and Interventional Neurology, Heitman Foundation for Stroke; data safety monitoring board for a trial sponsored by Rapid Medical. N.M.C. No relevant relationships. K.E.N. No relevant relationships. A.A. No relevant relationships. L.M. No relevant relationships. A.D. Advisory board for MIVI Neuroscience (Daise trial). F.B. No relevant relationships. G.F. No relevant relationships. A.R. No relevant relationships. S. Saleme No relevant relationships. C.M. No relevant relationships. J.F. Consulting fees from Acandis, Phenox, Stryker, Medtronic, Cerenovus, Penumbra, Roche; lecture honoraria from Acandis, Phenox, Medtronic, Cerenovus, Penumbra, TG medical, Microvention; advisory board for Phenox, Medtronic; president of ESMINT; stock options in Vastrax, Eppdata, Tegus. A.L.K. No relevant relationships. A.S.P. Consultant for Stryker, Cerenovus, Route 92, Merit, Agile; advisory board for CereVasc, Kaneka Medical, PICASSO study; stock options in InNeuroCo, NTI, Galaxy, Agile, Perfuze, Neosoma. C.D. No relevant relationships. P.T.K. Grants or contracts from NIH (1U18EB029353-01, UG3NS128397), Siemens Healthineers (CON30434), Joe Niekro Foundation (CON30914), Medtronic (ERP-2019-12070); consulting fees from Stryker Neurovascular; editorial board for Journal of Neurointerventional Surgery; shareholder and/or stock ownership Vena Medical, Deinde, Prometheus, Neurofine, Vented. M.C. No relevant relationships. G.M. Consulting fees from Stryker Neurovascular, Balt SAS, Microvention Europe, Sim & Cure; lecture payments from Phenox, Medtronic, Bracco, Penumbra, Johnson & Jonhson. J.B. No relevant relationships. X.B. No relevant relationships. I.S. No relevant relationships. S.N. No relevant relationships. N.H. Institutional grants or contracts from NIH–National Institute of Neurological Disorders and Stroke (NS131756, MPI U24NS113844), NIH–National Institute of Nursing Research (PI NR020231), Department of Defense–Congressionally Directed Medical Research Programs (Co-I DOD/W81XWH-20-1-0271); fees for other services from Myrobalan, General Dynamics; meeting and/or travel support from Massachusetts General Hospital, Neuro-AFib Investigator Meeting; editorial board member for Stroke; research committee for World Stroke Organization; executive board member of Advanced MRI Center (AMRIC). T.R.M. Patents planned, issued, or pending and stock options with eclips (evasc); proctor for Stryker, Medtronic, Balt. C.J.S. Advisory board for Zoll Circulation. J.D.R. No relevant relationships. T.O. No relevant relationships. S.D. No relevant relationships. L.L.L.Y. Patents planned, issued, or pending with NUHS; stock in CeroFlo. B.Y.Q.T. No relevant relationships. J.C.M.G. No relevant relationships. S.S.M. No relevant relationships. S. Sheth No relevant relationships. L.R. No relevant relationships. C.C. No relevant relationships. A.M. No relevant relationships. N.A. No relevant relationships. H.H.C.S. No relevant relationships. S.I.T. Consulting fees from MicroVention. P.J. No relevant relationships. P. Khandelwal Consulting fees from Penumbra, Stryker, Medtronic; meeting and/or travel support from Penumbra. A.B. No relevant relationships. F.C. No relevant relationships. M.E. No relevant relationships. K.P. No relevant relationships. I.V. No relevant relationships. A.P. No relevant relationships. J.P.F. Meeting and/or travel support from Stryker, Medtronic. R.V. No relevant relationships. M.Q.C. No relevant relationships. N.R.G. Patents planned, issued, or pending with Cedars-Sinai Medical Center; advisory board for Medtronic, DSMB. M.A.M. Grants or contracts from Balt, Medtronic, MicroVention, Stryker; consulting fees from CERENOVUS, Siemens Healthineers. J.J. No relevant relationships. V.C. Grants from Medtronic, Stryker, Balt, CERENOVUS; education training program consulting fees from Medtronic, Stryker, MicroVention; leadership role for Sim & Cure, Master & Fellow. A.t.S. No relevant relationships. V.Y. No relevant relationships. P.H. No relevant relationships. L.M.C. No relevant relationships. Y.A. No relevant relationships. B.G. No relevant relationships. C.P.S. Consulting fees Balt, France; lecture payment from Rapid Medical. C.H. Meeting and/or travel support from Johnson & Johnson. R.K. Grants or contracts from NIH, CERENOVUS, Medtronic, Endovascular Engineering, Frontier Bio, Sensome, Endomimetics, Ancure, Neurogami Medical, MIVI Neuroscience, Monarch Biosciences, Stryker, Conway Medical, Piraeus Medical, Bionaut Labs. M.K.O. No relevant relationships. C.J.G. Consulting fees from Penumbra, Stryker, Medtronic. A.J.T. CHESS grant from NIH; consulting fees from Phillips; expert testimony payment from CRICO, Kaiser Permanente; stock or stock options in Qure.ai and Neurofine. C.Y.H. Patents planned, issued, or pending with Tainan Sin Lau Hospital. D.S.L. Consulting fees from CERENOVUS, Genentech, Medtronic, Stryker, Rapid Medical. R.A.R. No relevant relationships. A.M.A. No relevant relationships. I.T. No relevant relationships. T.D.F. No relevant relationships. R.F. No relevant relationships. C.W. No relevant relationships. B.L. No relevant relationships. A.B.P. Consulting fees from MicroVention, Penumbra, Medtronic; lecture payment from MicroVention. V.M.P. No relevant relationships. A.G. No relevant relationships.

Figures

Flowchart shows study inclusion and exclusion before and after
propensity score matching. IVT = intravenous thrombolysis, MT = mechanical
thrombectomy. — **Figure 1:**
Flowchart shows study inclusion and exclusion before and after propensity score matching. IVT = intravenous thrombolysis, MT = mechanical thrombectomy.

Imaging in a 64-year-old male patient, with a baseline modified Rankin
Scale score of 0, who underwent mechanical thrombectomy (MT) due to speech
deficits and concern for deterioration. (A) Axial noncontrast head CT image
shows a small area of hypodensity in the left insular region (arrow). (B)
Axial CT angiographic maximum intensity projection image shows occlusion of
an inferior division M2 branch (arrow). (C) Lateral cerebral angiogram shows
the left inferior division M2 occlusion (arrow). (D) Lateral image shows a
balloon guide catheter in the distal cervical internal carotid artery
(arrowhead) and both a stent retriever and aspiration catheter (arrow)
during the MT procedure. (E) Follow-up lateral cerebral angiogram after the
thrombectomy pass shows complete recanalization (arrow). (F) Axial
diffusion-weighted MRI scan shows a small left insular infarct
(arrow). — **Figure 2:**
Imaging in a 64-year-old male patient, with a baseline modified Rankin Scale score of 0, who underwent mechanical thrombectomy (MT) due to speech deficits and concern for deterioration. **(A)** Axial noncontrast head CT image shows a small area of hypodensity in the left insular region (arrow). **(B)** Axial CT angiographic maximum intensity projection image shows occlusion of an inferior division M2 branch (arrow). **(C)** Lateral cerebral angiogram shows the left inferior division M2 occlusion (arrow). **(D)** Lateral image shows a balloon guide catheter in the distal cervical internal carotid artery (arrowhead) and both a stent retriever and aspiration catheter (arrow) during the MT procedure. **(E)** Follow-up lateral cerebral angiogram after the thrombectomy pass shows complete recanalization (arrow). **(F)** Axial diffusion-weighted MRI scan shows a small left insular infarct (arrow).

Imaging in an 83-year-old male patient with hypertension, diabetes,
and a mechanical aortic valve (on Coumadin therapy) who was last known well
5 hours prior. The patient had aphasia and right-sided weakness, indicating
a National Institutes of Health Stroke Scale score of 8. (A) Sagittal CT
angiogram shows a distal left M2 occlusion (arrow). A decision was made to
proceed with mechanical thrombectomy. (B) Anteroposterior arch angiogram
shows a bovine arch and severe left common carotid tortuosity (arrow) in the
internal carotid artery, which made it technically challenging to advance
the system when femoral access was initially pursued. (C) Anteroposterior
left common carotid angiogram shows subsequent radial access into left
internal carotid artery (LICA) (arrow). (D) Oblique angiogram shows a distal
left M2 occlusion (arrow). (E) Oblique angiogram shows the combined stent
retriever and aspiration catheter used during single-pass thrombectomy. (F)
Oblique angiogram shows the recanalized M2 segment (arrow), indicating a
Thrombolysis in Cerebral Infarction grade 3 (successful reperfusion) was
achieved. — **Figure 3:**
Imaging in an 83-year-old male patient with hypertension, diabetes, and a mechanical aortic valve (on Coumadin therapy) who was last known well 5 hours prior. The patient had aphasia and right-sided weakness, indicating a National Institutes of Health Stroke Scale score of 8. **(A)** Sagittal CT angiogram shows a distal left M2 occlusion (arrow). A decision was made to proceed with mechanical thrombectomy. **(B)** Anteroposterior arch angiogram shows a bovine arch and severe left common carotid tortuosity (arrow) in the internal carotid artery, which made it technically challenging to advance the system when femoral access was initially pursued. **(C)** Anteroposterior left common carotid angiogram shows subsequent radial access into left internal carotid artery (LICA) (arrow). **(D)** Oblique angiogram shows a distal left M2 occlusion (arrow). **(E)** Oblique angiogram shows the combined stent retriever and aspiration catheter used during single-pass thrombectomy. **(F)** Oblique angiogram shows the recanalized M2 segment (arrow), indicating a Thrombolysis in Cerebral Infarction grade 3 (successful reperfusion) was achieved.

Sankey diagram shows the distribution of modified Rankin Scale (mRS)
scores among patients before stroke (left) and 90 days after stroke (right)
categorized according to the type of treatment received, either mechanical
thrombectomy (MT) alone or in combination with intravenous thrombolysis
(IVT). — **Figure 4:**
Sankey diagram shows the distribution of modified Rankin Scale (mRS) scores among patients before stroke (left) and 90 days after stroke (right) categorized according to the type of treatment received, either mechanical thrombectomy (MT) alone or in combination with intravenous thrombolysis (IVT).

See this image and copyright information in PMC

References

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1. Goyal M , Menon BK , van Zwam WH , et al . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials . Lancet 2016. ; 387 ( 10029 ): 1723 – 1731 . - PubMed
1. Yang P , Zhang Y , Zhang L , et al . Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke . N Engl J Med 2020. ; 382 ( 21 ): 1981 – 1993 . - PubMed
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Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion

Affiliation

Assessment of Thrombectomy versus Combined Thrombolysis and Thrombectomy in Patients with Acute Ischemic Stroke and Medium Vessel Occlusion

Authors

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Abstract

Conflict of interest statement

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