Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke
Xu Tong, Yilong Wang, Jens Fiehler, Clayton T. Bauer, Baixue Jia, Xuelei Zhang, Xiaochuan Huo, Gang Luo, Anxin Wang, Yuesong Pan, Ning Ma, Feng Gao, Dapeng Mo, Ligang Song, Xuan Sun, Lian Liu, Yiming Deng, Xiaoqing Li, Bo Wang, Gaoting Ma, Yongjun Wang, Zeguang Ren, Zhongrong Miao, Zhongrong Miao, Liqiang Gui, Cunfeng Song, Ya Peng, Jin Wu, Shijun Zhao, Junfeng Zhao, Zhiming Zhou, Yongli Li, Jing Ping, Lei Yang, Yajie Liu, Qingshi Zhao, Yan Liu, Xiaoxiang Peng, Qingchun Gao, Zaiyu Guo, Wenhuo Chen, Weirong Li, Xiaojiang Cheng, Yun Xu, Yongqiang Zhang, Guilian Zhang, Yijiu Lu, Xinyu Lu, Dengxiang Wang, Yan Wang, Hao Li, Hua Yang, Deqin Geng, Haicheng Yuan, Hongwei Wang, Haihua Yang, Zengwu Wang, Liping Wei, Xuancong Liufu, Xiangqun Shi, Juntao Li, Wenwu Yang, Wenji Jing, Yong Xiang, Leyuan Wang, Chunlei Li, Yibin Cao, Qingfeng Zhu, Peng Zhang, Xiang Luo, Shengli Chen, WenWu Peng, Lixin Wang, Xue Wen, Shugui Shi, Wanming Wang, Bo Wang, Pu Yuan, Dong Wang, Haitao Guan, Wenbao Liang, Daliang Ma, Long Chen, Yanping Xiao, Xiangdong Xie, Zhonghua Shi, Xiangjun Zeng, Fanfan Su, Mingze Chang, Jijun Yin, Hongxia Sun, Chong Li, Yong Bi, Gang Xie, Yuwu Zhao, Chao Wang, Peng Zhang, Xianjun Wang, Dongqun Li, Hui Liang
Abstract
A recent randomized controlled trial DIRECT-MT (Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals) compared the safety and efficacy of mechanical thrombectomy (MT) versus combined intravenous thrombolysis (IVT) and MT for acute large vessel occlusion. The current study utilized a prospective, nationwide registry to validate the results of the DIRECT-MT trial in a real-world practice setting. Subjects were selected from a prospective cohort of acute large vessel occlusion patients undergoing endovascular treatment at 111 hospitals from 26 provinces in China (ANGEL-ACT registry [Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke]) between November 2017 and March 2019. All patients eligible for IVT and receiving MT were reviewed and then grouped according to whether prior IVT or not (MT and combined IVT+MT). After a 1:1 propensity score matching, the outcome measures including the 90-day modified Rankin Scale, successful recanalization, door-to-puncture time, symptomatic intracranial hemorrhage, and intraprocedural embolization were compared. A total of 1026 patients, 600 in the MT group and 426 in the combined group, were included. Among 788 patients identified after matching, there were no significant differences in the 90-day modified Rankin Scale (median, 3 versus 3 points; P=0.82) and successful recanalization (86.6% versus 89.3%; P=0.23) between the two groups; however, patients of the MT group had a shorter door-to-puncture time (median, 112 versus 136 minutes; β=−45.02 [95% CI, −68.31 to −21.74]), lower rates of symptomatic intracranial hemorrhage (5.5% versus 10.1%; odds ratio, 0.52 [95% CI, 0.30–0.91]), and embolization (4.6% versus 8.1%; odds ratio, 0.54 [95% CI, 0.30–0.98]) than those of the combined group. This matched-control study largely confirmed the findings of the DIRECT-MT trial in a real-world practice setting, suggesting that MT may carry similar effectiveness to combined IVT+MT for acute large vessel occlusion patients, despite MT alone seems to be associated with a shorter in-hospital delay until procedure, lower risks of symptomatic intracranial hemorrhage, and embolization. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939