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Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different

2017; Lippincott Williams & Wilkins; Volume: 48; Issue: 2 Linguagem: Inglês

10.1161/strokeaha.116.015857

1524-4628

Sònia Abilleira, Aída Ribera, Pedro Cardona, Marta Rubiera, Elena López‐Cancio, Sergio Amaro, Ana Rodríguez-Campello, Pol Camps‐Renom, David Cánovas, Maria Angels de Miquel, Alejandro Tomasello, Sebastián Remollo, Antonio López‐Rueda, Elío Vivas, J. Perendreu, Miquel Gallofré, Joan Martí‐Fàbregas, Raquel Delgado‐Mederos, Alejandro Martínez‐Domeño, Rebeca Marín, Jaume Roquer, Ángel Ois, Jordi Jiménez‐Conde, Léopoldo Guimaraens, Ángel Chamorro, Vı́ctor Obach, Xabier Urra, Juan Macho, Jordi Blasco, Luís San Román, Antonio Martı́nez-Yélamos, H. Quesada, B Lara, Núria Cayuela, Lucía Aja, Paloma Mora, Carlos A. Molina, Marc Ribó, Jorge Pagola, David Rodríguez‐Luna, Marián Muchada, Pilar Coscojuela, Antoni Dávalos, Mónica Millán, Natàlia Pérez de la Ossa, Meritxell Gomis, Laura Dorado, Carlos Castaño, M.C. Garcia, J. Estela, Jerzy Krupiński, Sonia Huertas-Folch, M. Carme Nicolás-Herrerias, Manuel Gómez‐Choco, Sònia García, Raúl Martínez‐Fernández, Jordi Sanahuja, Francisco Purroy, Joaquı́n Serena, Mar Castellanos, Yolanda Silva, Rafael Marés, Anna Pellisé, Xavier Ustrell, Joan Josep Baiges, Moisès Garcés, Júlia Saura, J.M. Soler-Insa, Josep Maria Aragonés, Dolores Cocho, Ernest Palomeras,

Peripheral Artery Disease Management

Background and Purpose— Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. Methods— Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel–Haenszel test statistic. Results— We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74–1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74–1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25–1.27). Conclusions— This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.