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MEDIUM-TERM PROGNOSIS IN PATIENTS WITH ACUTE ISCHEMIC STROKE SUBMITTED TO MECHANICAL THROMBECTOMY WITH OR WITHOUT INTRAVENOUS THROMBOLYSIS

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ESOC-2019

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Abstract

Introduction: Mechanical thrombectomy (MT) improves the functional outcome of patients with acute ischemic stroke and a large vessel occlusion. Intravenous thrombolysis (rtPA) within 4.5h is recommended before or during MT, in the absence of contraindications. Objective: We intended to identify the reasons for not using rtPA on patients undergoing MT and evaluate their 90-days outcome. Methodology: Retrospective review of prospectively collected database for consecutive patients with the diagnosis of acute ischemic stroke submitted to MT between January 2015 and August 2018 in a tertiary centre. The population was divided in two groups: previously treated with rtPA and non-treated with rtPA. Reasons for non-thrombolysis were identified. Data analysed included demographic data, vascular risk factors, NIHSS score at admission, twenty-four hours and discharge, modified Rankin scale at admission and three months and 90-day mortality. Results: From the 473 patients submitted to acute stroke treatment, 107 underwent MT. These one were divided in two groups: MT (N=56, mean age: 69.6±20.5years, 67,8%: male, 70%: TACI) and rtPA+MT (N=51, mean age: 69.6±19.6years, 58.8%: male, 67.6% TACI). MT group presented an increased frequency of auricular fibrillation, type 2 diabetes and alcohol ingestion. The main reasons for non-thrombolysis were: treatment with anticoagulants (n=18), >4.5h from symptoms onset (n=10), prothrombin time>15secs (n=5) and international normalised ratio>1.7 (n=4) and previous gastrointestinal and intracranial haemorrhages (n=4). Complete perfusion rates (TICI 3) were higher on rtpa+MT group (50.0% vs 22.6%). The most prevalent treatment complications on rtPA+MT group were intracranial haemorrhages (n=14), embolization to another territory (n=4), inguinal hematoma (n=3) and angioedema (n=2). On MT group, the most prevalent complications were intracranial haemorrhages (n=7), embolization (n=3) and inguinal hematoma (n=1). Ninety-day functional independence was similar in both groups, while mortality was slightly increased on MT group (17.5% vs 12.8%). Conclusion: Although patients included on each group had different clinical characteristics, there were no differences on functional independence and mortality at three months, albeit with a slight increase of haemorrhagic complications on rtPA+MT group.

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© Copyright 2019 Morressier GmbH.
All rights reserved.