Literature Review

Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different

Rodrigo RIVERA

Nowadays the standard of care for ischemic stroke treatment under 4.5h is IV rTPA (IVT)  + mechanical thrombectomy (Endovascular Treatment – EVT-)  when large vessel occlusion (LVO) of anterior circulation is detected. In several stroke centers nowadays the question of the real need of previous IV treatment has been questioned, moreover if this could delay the transfer to an endovascular center and mechanical revascularization.
Time is crucial when opening an artery, and any delay could affect outcome as it has been published.

In this paper, the group from Catalonia compared two groups, one that received IVT + EVT vs EVT from a review of the SONIA registry system. The direct EVT (dEVT) group was selected when there were contraindications for IVT. The where some clinical differences between the dEVT vs the IVT group: More patients with atrial fibrillation, heart failure, oral anticoagulation, previous stroke and more delay of onset of EVT in the dEVT group. Nevertheless, after stratification, there were no differences in outcomes at 90 days, death or bleedings between the two groups.