Functional outcome after mechanical thrombectomy with or without previous thrombolysis

Introduction: Combined intravenous therapy (IVT) and mechanical thrombectomy (MT) is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO). However, the use of IVT before MT is recently being questioned. Objectives: To compare patients treated with IVT before MT with those treated with MT alone, in a real-world scenario. Methods: Retrospective analysis of AIS patients with LVO of the anterior circulation who underwent MT, with or without previous IVT, between 2016 and 2018. Results: A total of 524 patients were included (347 submitted to IVT+MT; 177 to MT alone). No differences between groups were found except for a higher time from stroke onset to CT and to groin puncture in the MT group (297.5 min vs 115.0 min and 394.0 min vs 250.0 min respectively, p < 0.001). Multivariable analysis showed that age<75 years (OR 2.65, 95% CI 1.71–4.07, p < 0.001), not using antiplatelet therapy (OR 1.93, 95% CI 1.21–3.08, p = 0.006), low prestroke mRS (OR 4.33, 95% CI 1.89–9.89, p < 0.001), initial NIHSS (OR 0.89, 95% CI 0.86–0.93, p < 0.001), absent cerebral edema (OR 7.83, 95% CI 3.31–18.51, p < 0.001), and mTICI 2b/3 (OR 4.56, 95% CI 2.17–9.59, p < 0.001) were independently associated with good outcome (mRS 0-2). Conclusions: Our findings support the idea that IVT before MT does not influence prognosis, in a real-world setting.