Outcomes After Direct Thrombectomy or Combined Intravenous and Endovascular Treatment Are Not Different
Por:
Abilleira, S, Ribera, A, Cardona, P, Rubiera, M, Lopez-Cancio, E, Amaro, S, Rodriguez-Campello, A, Camps-Renom, P, Canovas, D, de Miquel, MA, Tomasello, A, Remollo, S, Lopez-Rueda, A, Vivas, E, Perendreu, J and Gallofre, M
Publicada:
1 feb 2017
Resumen:
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.
Filiaciones:
Abilleira, S:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, Roc Boronat 81-95,2nd Floor, Barcelona 08005, Spain
CIBERESP, Barcelona, Spain
Ribera, A:
Hosp Valle De Hebron, Dept Cardiol, Cardiovasc Epidemiol Unit, Barcelona, Spain
Cardona, P:
Bellvitge Hosp, Dept Neurol, Lhospitalet De Llobregat, Spain
Rubiera, M:
Hosp Valle De Hebron, Dept Neurol, Stroke Unit, Barcelona, Spain
Lopez-Cancio, E:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Badalona, Spain
Amaro, S:
Hosp Clin Barcelona, Dept Neurosci, Barcelona, Spain
Rodriguez-Campello, A:
IMIM Hosp del Mar, Dept Neurol, Barcelona, Spain
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Canovas, D:
Hosp Parc Tauli, Dept Neurol, Sabadell, Spain
de Miquel, MA:
Bellvitge Hosp, Dept Endovasc Neuroradiol, Lhospitalet De Llobregat, Spain
Tomasello, A:
Hosp Valle De Hebron, Neurointervent Dept, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Badalona, Spain
Lopez-Rueda, A:
Hosp Clin Barcelona, Dept Neuroradiol, Barcelona, Spain
Vivas, E:
Hosp del Mar, Dept Intervent Neuroradiol, Barcelona, Spain
Perendreu, J:
Hosp Parc Tauli, Dept Neuroradiol, Sabadell, Spain
Gallofre, M:
Agcy Hlth Qual & Assessment Catalonia, Stroke Program, Roc Boronat 81-95,2nd Floor, Barcelona 08005, Spain
CIBERESP, Barcelona, Spain
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