Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Collections
    • Subjects A-Z
    • Residents & Fellows
    • Patient Pages
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Collections
    • Subjects A-Z
    • Residents & Fellows
    • Patient Pages
  • Podcast
  • CME
    • Article CME
    • Podcast CME
  • About
    • About the Journals
    • Contact Us
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

April 10, 2018; 90 (15) Article

Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T. Froehler, J. Mocco, Abhi Pandhi, Ramin Zand, Konark Malhotra, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D. Turner, Justin Mascitelli, Kiersten Espaillat, Aristeidis H. Katsanos, Anne W. Alexandrov, Andrei V. Alexandrov, Adam S. Arthur
First published March 16, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005299
Nitin Goyal
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Georgios Tsivgoulis
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Donald Frei
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Aquilla Turk
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Blaise Baxter
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael T. Froehler
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
J. Mocco
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abhi Pandhi
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ramin Zand
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Konark Malhotra
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Daniel Hoit
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lucas Elijovich
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David Loy
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Raymond D. Turner
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Justin Mascitelli
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kiersten Espaillat
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Aristeidis H. Katsanos
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne W. Alexandrov
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrei V. Alexandrov
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adam S. Arthur
From the Department of Neurology (N.G., G.T., A.P., R.Z., L.E., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T., A.H.K.), “Attikon University Hospital,” School of Medicine, University of Athens, Greece; International Clinical Research Center (G.T.), St. Anne's Hospital, Brno, Czech Republic; Department of Interventional Neuroradiology (D.F., D.L.), Radiology Imaging Associates, Englewood, CO; Department of Neurosurgery (A.T., R.D.T.), Medical University of South Carolina, Charleston; Department of Interventional Neuroradiology (B.B.), Erlanger Hospital, Chattanooga; Cerebrovascular Program (M.T.F., K.E.), Vanderbilt University, Nashville, TN; Department of Neurosurgery (J. Mocco, J. Mascitelli), Mount Sinai Medical Center, New York, NY; Charleston Area Medical Center (K.M.), West Virginia University; and Department of Neurosurgery (D.H., L.E., A.S.A.), University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion
Nitin Goyal, Georgios Tsivgoulis, Donald Frei, Aquilla Turk, Blaise Baxter, Michael T. Froehler, J. Mocco, Abhi Pandhi, Ramin Zand, Konark Malhotra, Daniel Hoit, Lucas Elijovich, David Loy, Raymond D. Turner, Justin Mascitelli, Kiersten Espaillat, Aristeidis H. Katsanos, Anne W. Alexandrov, Andrei V. Alexandrov, Adam S. Arthur
Neurology Apr 2018, 90 (15) e1274-e1282; DOI: 10.1212/WNL.0000000000005299

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Comment

Downloads
275

Share

  • Article
  • Figures & Data
  • Info
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Objective In this multicenter study, we sought to evaluate comparative safety and efficacy of combined IV thrombolysis (IVT) and mechanical thrombectomy (MT) vs direct MT in emergent large vessel occlusion (ELVO) patients.

Methods Consecutive ELVO patients treated with MT at 6 high-volume endovascular centers were evaluated. Standard safety and efficacy outcomes (successful reperfusion [modified Thrombolysis in Cerebral Infarction IIb/III], functional independence [FI] [modified Rankin Scale (mRS) score of 0–2 at 3 months], favorable functional outcome [mRS of 0–1 at 3 months], functional improvement [mRS shift by 1-point decrease in mRS score]) were compared between patients who underwent combined IVT and MT vs MT alone. Additional propensity score–matched analyses were performed.

Results A total of 292 and 277 patients were treated with combination therapy and direct MT, respectively. The combination therapy group had greater functional improvement (p = 0.037) at 3 months. After propensity score matching, 104 patients in the direct MT group were matched to 208 patients in the combination therapy group. IVT pretreatment was independently (p < 0.05) associated with higher odds of FI (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.02–2.99) and functional improvement (common OR 1.64; 95% CI 1.05–2.56). Combination therapy was independently (p < 0.05) related to lower likelihood of 3-month mortality (0.50; 95% CI 0.26–0.96).

Conclusions This observational study provides preliminary evidence that IVT pretreatment may improve outcomes in ELVO patients treated with MT. The question of the potential effect of IVT on ELVO patients treated with MT should be addressed with a randomized controlled trial.

Classification of evidence This study provides Class III evidence that for stroke patients with emergent large vessel occlusion, combined IVT and MT is superior to direct MT in improving functional outcomes.

Glossary

AIS=
acute ischemic stroke;
ASPECTS=
Alberta Stroke Program Early CT Score;
CI=
confidence interval;
cOR=
common odds ratio;
ELVO=
emergent large vessel occlusion;
ESCAPE=
Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke;
FFO=
favorable functional outcome;
FI=
functional independence;
INT=
infarct in a new previously unaffected territory;
IRB=
institutional review board;
IVT=
IV thrombolysis;
MCA=
middle cerebral artery;
mRS=
modified Rankin Scale;
MT=
mechanical thrombectomy;
mTICI=
modified Thrombolysis in Cerebral Infarction;
NIHSS=
NIH Stroke Scale;
OR=
odds ratio;
PSM=
propensity score matching;
sICH=
symptomatic intracranial hemorrhage;
STAR=
Solitaire FR Thrombectomy for Acute Revascularisation;
SWIFT=
Solitaire FR with the Intention for Thrombectomy;
tPA=
tissue plasminogen activator

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 673

  • Class of Evidence: NPub.org/coe

  • Received August 7, 2017.
  • Accepted in final form December 27, 2017.
  • © 2018 American Academy of Neurology
View Full Text

AAN Members: Sign in with your AAN member credentials (e-mail or 6-digit Member ID number)

Non-AAN Member subscribers: Sign in with subscriber credentials

Log in using your username and password

Forgot your user name or password?

Purchase access

AAN members must change their passwords on the AAN site

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  

Disputes & Debates: Rapid online correspondence

  • Author response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion
    Nitin Goyal, Georgios Tsivgoulis, Andrei V. Alexandrov and Adam S. Arthur
    Published September 03, 2018
  • Reader response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion
    Natalie E. LeCouffe, Kilian M. Treurniet, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos and Jonathan M. Coutinho
    Published June 15, 2018
  • Pre-procedural thrombolysis may mitigate new infarcts and deficits in unexpectedly challenging thrombectomies
    Aravind Ganesh, Bijoy K. Menon, Mayank Goyal, Andrew M. Demchuk and Michael D. Hill
    Published April 12, 2018
Comment

NOTE: All contributors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.

  • Stay timely. Submit only on articles published within the last 8 weeks.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • 200 words maximum.
  • 5 references maximum. Reference 1 must be the article on which you are commenting.
  • 5 authors maximum. Exception: replies can include all original authors of the article.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All contributors, besides the first/corresponding author, must complete a separate Disputes & Debates Submission Form and provide via email to the editorial office before comments can be posted.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Author contributions
    • Study funding
    • Disclosure
    • Acknowledgment
    • Footnotes
    • References
  • Figures & Data
  • Info

Related Articles

  • Are we close to the twilight of IV thrombolysis for acute ischemic stroke patients with large vessel occlusion?

Topics Discussed

  • All Cerebrovascular disease/Stroke

Alert Me

  • Alert me when this article is cited
  • Alert me if a correction is posted
  • Alert me when eletters are published
Advertisement
Neurology: 92 (7)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2019 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise