Comparison of two bridging procedures using alteplase in acute ischemic stroke: Combined venous and arterial thrombolysis versus combined venous thrombolysis and mechanical therapy

Abstract

Purpose: To compare recanalization rates and clinical outcome of two bridging procedures in acute stroke: venous and arterial thrombolysis versus venous thrombolysis and mechanical therapy. Methods: All consecutive patients with ischemic stroke in the anterior circulation admitted within a 3-hour window from 2006 to 2009 were reviewed. In the first group, all patients underwent sequentially venous and arterial therapy with the half dose of tPA (0.9 mg/kg) administered intravenously during the first 30 minutes and the remaining half given intra-arterially. In the second group the half dose of tPA was also administered intravenously before mechanical aspiration using the Penumbra system. When necessary, patients received intra-arterial tPA as well. Initial site of occlusion was determined by CT-angiography. Recanalization was assessed by means of thrombolysis in myocardial infarction (TIMI) scores at the end of the endovascular procedure. Clinical outcome was assessed at 3 months according to modified Rankin scale. Results: Fifty-five patients were included in the study, 30 with combined venous and arterial and 25 with venous followed by mechanical thromboaspiration. There were no significant differences between the two groups regarding baseline characteristics and hemorrhagic complications. Although recanalization rates (TIMI 2 and 3) were clearly higher in the mechanical group (57% vs 92%, p< 0.001), no difference was observed for the clinical outcome (43% vs 32%, p=NS). Patients with complete recanalization (TIMI 3) presented a better prognosis then those with partial reperfusion irrespective of the procedure type (p< 0.02 and p< 0.001 respectively for the groups). Conclusions: No difference was observed regarding clinical outcome between the two bridging procedures, despite higher rates of recanalization in the group with mechanical therapy. Favourable clinical outcome was strongly related to complete recanalization which was achieved in similar proportions in both groups.