Background and Purpose: The impact of prior intravenous thrombolysis using low dose (0.6mg/kg) alteplase on outcomes in large vessel acute stroke patients undergoing endovascular therapy remains unclear.
Methods: In a Japanese nationwide registry study, 2420 patients with acute stroke due to LVO were registered between October 2014 and January 2017. Among them, 595 patients with occlusion of the internal carotid artery or the middle cerebral artery M1 portion and who underwent endovascular therapy within 6 hours after onset were analyzed. Prior intravenous thrombolysis (IVT) with low dose alteplase was performed in 368 (62%) patients. Functional outcome was assessed by modified Rankin Scale (mRS) score at 90 days, and symptomatic intracranial hemorrhage (sICH) was evaluate within 72 hours.
Results: In patients with IVT, previous stroke and prior anticoagulant therapy were less common, baseline Alberta Stroke Program Early CT Score was higher, and time from onset to arterial puncture was shorter than in those without IVT. Compared to IVT (-) group, independency (mRS 0-2) and independent ambulation (mRS 0-3) were more frequent in IVT (+) group (49% vs 40%, P=0.04, and 64% vs 49%, P<0.01, respectively). Prior IVT was associated with independent ambulation (adjusted odds ratio [aOR] 1.63, 95%CI 1.05-2.53) but not with independency (aOR 1.21, 95%CI 0.78-1.88) after adjustment for potential confounders. Also, it did not increase odds of sICH (2.9% vs 2.9%, aOR 1.07, 95%CI 0.35-3.36).
Conclusions: Prior IVT with low dose alteplase before endovascular therapy can modestly improve functional outcome without increasing risk of sICH in acute stroke patients.

ENDOVASCULAR THERAPY WITH OR WITHOUT INTRAVENOUS LOW DOSE ALTEPLASE IN ACUTE STROKE PATIENTS WITH ANTERIOR LARGE VESSEL OCCLUSION