Comparing outcome and recanalization results in patients with anterior circulation stroke following endovascular treatment with and without a treatment with rt‐PA: A single‐center study

OBJECTIVES: Endovascular treatment (ET), in addition to a therapy with intravenous recombinant tissue plasminogen activator IV rt‐PA in patients with acute ischemic stroke, has been found to improve outcome. However, data about ET in patients who have not received therapy with rt‐PA due to contraindications for IV rt‐PA are sparse. Comparison of ET with IV rt‐PA versus ET alone in patients with stroke is done using a proximal intracranial arterial occlusion (internal carotid artery, middle cerebral artery (M1‐Segment)). METHODS: During a 5‐year period (2011–2016), 236 patients (mean age, 69 ± 14 years; 46% women; median NIHSS score 13 ± 5) who were treated at the Department of Neurology and Neuroradiology at the University of Lübeck, undergoing ET with or without IV rt‐PA were included and analyzed. RESULTS: A total of 144 patients (61%) underwent ET + IV rt‐PA, and 92 patients (39%) underwent ET only. The ET with IV rt‐PA is associated with a higher rate of favorable functional outcomes (mRS≤2) at discharge from hospital (51.4% vs. 23.1%, p < .001) and lower rate of in‐hospital mortality (9% vs. 19.6%, p = .019) and symptomatic intracerebral hemorrhage [sICH] (2.1% vs. 8.7%; p = .019) compared to ET, whereas the modified treatment in cerebral infarction score (mTICI) did not differ between the groups. In the adjusted logistic regression analysis, the ET + IV rt‐PA was associated with an increased probability of favorable functional outcome (OR, 4.3; 95% confidence interval [CI], 2.2–8.5; p < .001). For the in‐hospital mortality (OR, 0.74; 95% CI, 0.29–1.9; p = .76) and sICH (OR, 0.3; 95% CI, 0.07–1.2; p = .09), no differences were found. CONCLUSION: Recanalization results after endovascular treatment are not relevantly improved in patients receiving rt‐PA. However, an additional therapy with IV rt‐PA has a positive impact on functional outcome.