Combined endovascular thrombectomy and intravenous thrombolysis: technical aspects and clinical outcomes from the Moscow stroke registry

Objective. To compare the technical aspects and clinical outcomes of endovascular thrombectomy (EVT) in patients with acute M1 or M2 middle cerebral artery (MCA) occlusion, according to the use of intravenous thrombolysis (IVT), in real-world clinical practice in the hospitals of the Moscow Stroke Network. Material and methods. The retrospective observational study included 801 patients from the Moscow Stroke Registry, hospitalized within 4.5 hours of symptom onset, with confirmed occlusion of the M1 or M2 segments of the MCA and EVT performed. The reperfusion grade (mTICI score), number of thrombectomy attempts, functional outcome at discharge (mRS score), and complication rates were assessed. The EVT group with IVT included 383 patients, and the EVT without IVT included 418 patients. Results. In patients who received systemic IVT, first-pass reperfusion was achieved more often (49.4% vs. 40.2%; aOR 1.44; 95% CI 1.09—1.91; p=0.011) and the number of thrombectomy attempts was lower (Me 1 1; 3 vs. 2 1; 3; aOR 0.72; 95% CI 0.56—0.94; p=0.014). The rate of successful reperfusion (mTICI 2b—3) did not differ between the groups (p=0.373). When clinical outcomes were compared, combined reperfusion therapy was associated with a more favorable distribution of mRS scores, a higher proportion of patients with mRS 0—3, and lower mortality. After adjustment for potential confounding factors, the statistical significance of the differences persisted only for in-hospital mortality (23.0% vs. 34.0%; aOR 0.61; 95% CI 0.44—0.84; p=0.003). The frequency of symptomatic hemorrhagic transformation did not differ between the groups (p=0.670). Conclusion. IVT was associated with a more frequent first-pass reperfusion, fewer thrombectomy attempts, and reduced in-hospital mortality with a comparable rate of symptomatic hemorrhagic transformation.