Bastin, R

Brorson, J

Carrión-Penagos, J

Coleman, E

Desai, H

Hneiny, Layal

Kass-Hout, T

Khamis, A

Kothari, S

Mansour, A

Mendelson, S

Morsi, R

Prabhakaran, S

Tannous, E

Tarabichi, A

Thind, S

English

USD RED (University of South Dakota)

University of South Dakota USD RED Faculty Publications University Libraries Spring 7-23-2022 Direct mechanical thrombectomy with or without bridging thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials R Morsi Department of Neurology, University of Chicago, Chicago, IL J Carrión-Penagos Department of Neurology, University of Chicago, Chicago, IL H Desai Department of Neurology, University of Chicago, Chicago, IL E Tannous Department of Medicine, Vanderbilt University Medical Center, Nashville, TN S Kothari Department of Neurology, University of Chicago, Chicago, IL See next page for additional authors Follow this and additional works at: https://red.library.usd.edu/ul-fp Recommended Citation Morsi R, Carrión-Penagos J, Desai H, et alO-068 Direct mechanical thrombectomy with or without bridging thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trialsJournal of NeuroInterventional Surgery 2022;14:A44-A45. This Article is brought to you for free and open access by the University Libraries at USD RED. It has been accepted for inclusion in Faculty Publications by an authorized administrator of USD RED. For more information, please contact dloftus@usd.edu. Authors R Morsi, J Carrión-Penagos, H Desai, E Tannous, S Kothari, A Khamis, A Tarabichi, R Bastin, Layal Hneiny, S Thind, E Coleman, J Brorson, S Mendelson, A Mansour, S Prabhakaran, and T Kass-Hout This article is available at USD RED: https://red.library.usd.edu/ul-fp/90 outcomes. However, without complete ingestion of the clot,much of it remains outside of the catheter and can be asource of distal emboli. Super Large Bore Aspiration (SLBA)has shown high rates of complete clot ingestion. We reportthe initial clinical feasibility, safety, and efficacy of this novelSLBA-insert combination- Super Large-bore Ingestion of Clot(SLIC technique) for stroke. SLIC entails a triaxial assemblyof an 8 Fr 0.106’ Base Camp catheter, 0.088’ catheterextender (HiPoint) and an insert catheter (Tenzing 8), thatcompletely consumes the inner diameter of the 0.088’ SLBAcatheter. The HiPoint catheter is delivered over the Tenzing 8to the face of the embolus, which is withdrawn, while aspirat-ing through the Base Camp and HiPoint catheters as a singleassembly.Materials and Methods Retrospective review of three compre-hensive stroke center databases between February 2021 andJanuary 2022 and identification of patients treated using theSLIC technique. Data collection and analysis was performedunder an Institutional Review Board approved protocol.Patient selection for endovascular treatment was based onadvanced imaging with non-contrast head CT, CT angiographyand/or CT perfusion. Patients included in this series werefound to have a large cerebral vessel occlusion with viableischemic penumbra (6–24 hours) in the vascular territory sup-plied by the occluded target artery. Clinical and proceduraldata of the group of patients undergoing SLIC thrombectomywere extracted.Results Thirty-three patients with large vessel occlusion weretreated with SLIC. Mean patient age was 70 years (range 30–91 years) and 17 patients were male (51.5%). The medianpresenting NIHSS was 21 (range 1–34) and median ASPECTSscore was 8 (range 5–10). Successful delivery of the 0.088’catheter to the site of the occlusion was achieved in all cases.Successful revascularization defined as mTICI2B was seen in100% using a single pass in most of the cases (82%). FinalmTICI2C was achieved in 94.1% of patients, with 73.5%mTICI3 recanalization. The rate of first-pass effect in achiev-ing excellent reperfusion defined as mTICI2C was seen in70.5% of cases. There were no adverse events or post-proce-dural symptomatic intracranial hemorrhages.Conclusion Our initial experience with the SLIC techniqueresulted in achieving first-pass effect (mTICI2C) in 70.5%.Navigation of the SLBA catheter extender over the Tenzinginsert was successful and safe in this early experience.Disclosures F. Massari: None. G. Dabus: 2; C; Medtronic,Microvention, Cerenovus, Penumbra, Stryker, InNeuroCo,Route 92. G. Cortez: None. J. Singh: None. A. Kuhn: None.V. Naragum: None. V. Anagnostakou: None. R. Hanel: 1; C;NIH, Interline Endowment, Microvention, Stryker and CNX.2; C; Medtronic, Balt, Stryker, Q’Apel medical, CodmanNeuro (J&J), Cerenovus, Microvention, Imperative Care, Phe-nox and Rapid Medical. M. Gounis: 1; C; the National Insti-tutes of Health (NIH), the United States – Israel BinationalScience Foundation, Anaconda, ApicBio, Arsenal Medical, Axo-vant, Balt, Cerenovus, Ceretrieve, CereVasc LLC, Cook Medi-cal,. 2; C; Alembic LLC, Astrocyte Pharmaceuticals, BendItTechnologies, Cerenovus, Imperative Care, Jacob’s Institute,Medtronic Neurovascular, Mivi Neurosciences, phenoxGMbH, Q’Apel, Route 92 Medical, Stryker. 4; C; ImperativeCare, InNeuroCo, Galaxy Therapeutics and Neurogami. A.Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neuro-vascular and Stryker Neurovascular. 2; C; for Medtronic Neu-rovascular, Stryker NeurovascularBalt, Q’Apel Medical,Cerenovus, Microvention, Imperative Care, Agile, Merit,CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Per-fuze, Galaxy and NTI.O-068 DIRECT MECHANICAL THROMBECTOMY WITH ORWITHOUT BRIDGING THROMBOLYSIS IN PATIENTS WITHACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW ANDMETA-ANALYSIS OF RANDOMIZED TRIALS1R Morsi*, 1J Carrión-Penagos, 1H Desai, 2E Tannous, 1S Kothari, 3A Khamis, 1A Tarabichi,1R Bastin, 4L Hneiny, 5S Thind, 1E Coleman, 1J Brorson, 1S Mendelson, 1A Mansour,1S Prabhakaran, 1T Kass-Hout. 1Department of Neurology, University of Chicago, Chicago,IL; 2Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; 3WolfsonPalliative Care Research Centre, Hull York Medical School, University of Hull, Heslington,UK; 4Wegner Health Science Information Center, University of South Dakota, Sioux Falls, SD;5Department of Surgery, University of Chicago, Chicago, IL10.1136/neurintsurg-2022-SNIS.68Introduction/Purpose Current published guidelines and meta-analyses comparing direct mechanical thrombectomy (MT)alone versus MT with bridging intravenous thrombolysis sug-gested that MT alone is non-inferior to MT with bridgingthrombolysis in achieving favorable functional outcome.Because of this controversy, we aimed to systematically updatethe evidence and meta-analyze data from randomized trialscomparing MT alone versus MT with bridging thrombolysis.Materials and Methods We searched three databases, MED-LINE (through Ovid), EMBASE, and the Cochrane Libraryfrom inception to December 14, 2021, to identify randomizedtrials comparing clinical outcomes, including favorable func-tional outcome and mortality at 90 days, successful reperfu-sion, defined as modified TICI score 2b, and symptomaticintracranial hemorrhage (sICH), between those who underwentMT alone and those who underwent MT with bridging throm-bolysis. We pooled and reported the incidence of these out-comes and calculated the measures of association by risk ratio(RR). We assessed the certainty of the evidence using theGrading of Recommendations, Assessment, Development andEvaluations (GRADE) approach, and the risk of bias of allincluded studies using the Cochrane risk-of-bias tool (RoB).Results Out of 11,109 citations, we identified 51 eligible stud-ies, and included six studies: two post-hoc analyses ofrandomized trials, and four randomized trials. The total num-ber of patients included was 2,305. The age (years) of thesubjects was 69.97 ± 12.28 (mean ± SD). All studies usedintravenous alteplase (0.6 – 0.9 mg/kg bolus) for thrombolysis.When comparing MT alone versus MT with bridging, wefound no statistically significant difference in favorable func-tional independence (RR, 1.07; 95% CI, 0.94, 1.21), mortalityat 90 days (RR, 0.83; 95% CI, 0.66, 1.06), successful reperfu-sion (RR, 1.04; 95% CI, 1.00, 1.07), or sICH (RR, 1.17;95% CI, 0.84, 1.64). Risk of bias was high across all identi-fied studies.Conclusion Our meta-analysis showed that adjunctive therapywith intravenous thrombolysis may not provide added benefitto patients undergoing mechanical thrombectomy in terms offunctional outcome, mortality, successful reperfusion, or symp-tomatic bleeding, which is consistent with previous analyses.Further research is needed to clarify which patient subgroupswould benefit from either modality.Disclosures R. Morsi: None. J. Carrión-Penagos: None. H.Desai: None. E. Tannous: None. S. Kothari: None. A. Kha-mis: None. A. Tarabichi: None. R. Bastin: None. L. Hneiny:None. S. Thind: None. E. Coleman: None. J. Brorson: None.AbstractsA44 J NeuroIntervent Surg 2022;14(Suppl 1):A1–A248by copyright. on July 29, 2022 at University of South Dakota. Protectedhttp://jnis.bmj.com/J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2022-SNIS.68 on 23 July 2022. Downloaded from S. Mendelson: None. A. Mansour: None. S. Prabhakaran:None. T. Kass-Hout: None.O-069 EFFECT OF INTRAVENOUS THROMBOLYSIS BEFOREENDOVASCULAR THERAPY ON OUTCOMES IN PATIENTSWITH LARGE CORE INFARCT: INSIGHT FROM THE STARREGISTRY1M Anadani*, 2A Shaban, 1S Al Kasab, 1R Chalhoub, 3I Maier, 4M Psychogios, 5A Alaweih,6S Wolfe, 7A Authur, 8T Dumont, 9P Kan, 10J Kim, 11R De Leacy, 12J Osbun, 13A Rai,14P Jabbour, 15M Park, 16J Mascitelli, 17M Levitt, 18A Polifka, 19W Casagranda,20S Yoshimura, 21C Matouk, 22R Williamson, 23B Gory, 24M Mokin, 25I Fragata,26D Romano, 27S Chowdry, 28M Moss, 29D Behme, 30K Limaye, 31A Spiotta, 2E Samaniego.1Neurological Surgery, Medical University of South Carolina, Charleston, SC; 2Neurology,University of Iowa, Iowa City, IA; 3Department of Neurology, University Medicine Göttingen,Göttingen, Germany; 4Neuroradiology, University Hospital Basel, Basel, Switzerland;5Neurosurgery, Emory University School of Medicine, Atlanta, GA; 6Neurosurgery, WakeForest School of Medicine, Winston-Salem, NC; 7Neurosurgery, University of TennesseeHealth Science Center, Memphis, TN; 8Neurosurgery, University of Arizona Health Sciences,Tucson, AZ; 9Neurology, Baylor School of Medicine, Houston, TX; 10Neurology, ChonnamNational University Hospital, Gwangju, Korea, Republic of; 11Neurosurgery, Mount SinaiHealth System, New York, NY; 12Neurosurgery, Washington University of School ofMedicine, St. Louis, MO; 13Neurosurgery, West Virginia School of Medicine, Morgantown,WV; 14Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, PA;15Neurosurgery, University of Virginia, Charlottesville, VA; 16Neurosurgery, University ofTexas Health Science Center at San Antonio, San Antonio, TX; 17Neursurgery, University ofWashington, Seattle, WA; 18Neurosurgery, University of Florida, Gainsville, FL;19Cerebrovascular and Endovascular Neurosurgery, Hospital Juan Fernandez, Buenos Aires,Argentina, Argentina, Argentina; 20Neurosurgery, Hyogo College of Medicine, Hyogo,Japan; 21Neurosurgery, Yale School of Medicine, New Haven, CT; 22Neurosurgery,Allegheny Health Network, Pittsburgh, PA; 23Diagnostic and Therapeutic Neuroradiology,Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; 24Neurosurgery,University of South Florida, Tampa, FL; 25Neuroradiology, Hospital São José CentroHospitalar, Lisboa, Portugal; 26Neuroscience, Aou S. Giovanni I Dio e Ruggi d'AragonaHospital, Salerno SA, Italy; 27Neurosurgery, NorthShore University Health System, Evanston,IL; 28Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, AR;29Neuroloradiology, University Hospital Magdeburg, Magdeburg, Germany; 30Neurology,Indiana University, Bloomington, IN; 31Neurosurgery, Medical University of South Carolina,Charleston, SC10.1136/neurintsurg-2022-SNIS.69Background The utility of intravenous thrombolysis (IVT)before mechanical thrombectomy (MT) remains a matter ofdebate. The data regarding the safety and efficacy of IVTprior to MT in patients with large core infarct is scarce.Objective To compare the functional and safety outcomesbetween patients with large core infarct due to LVO treatedwith IVT and MT to those treated with MT alone.Methods This is a retrospective analysis of the Stroke Throm-bectomy Aneurysm Registry (STAR). Large core infarct wasdefined as Albert Stroke Program Early CT Score (ASPECTS)≤5. Patients with large core infarct due to anterior circulationlarge vessel occlusion (internal carotid artery occlusion, M1segment occlusion, or tandem occlusion) treated with MTwere enrolled in this study. Patients were divided into twogroups based on pretreatment intravenous thrombolysis (IVT+, IVT-). The association between IVT and favorable outcome(mRS 0–2) or significant intracranial hemorrhage (PH2 orsICH) was assessed using a logistic regression model adjustedfor age, sex, admission NIHSS, onset to groin time, and pre-stroke mRS.Results Of 6151 patients enrolled in the STAR registry duringthe study period, 398 patients (mean age 67.5 14 years,median NIHSS 19, median onset to groin 321 minutes) metour inclusion criteria and were included in the final analysis.Favorable outcome was achieved in 27.3%, and 17.4% in theIVT+ and IVT- groups (p=0.027), respectively. SignificantICH (sICH or PH2) occurred in 16.9% and 13.1% in theIVT+ and IVT- groups (p-0.26), respectively. In an adjustedlogistic regression model, IVT was not associated with favor-able outcomes (OR, 1.78; 95% CI 0.91–3.48) or significanthemorrhage (OR, 1.36; 95% CI 0.71–2.59).Conclusion Patients with large core infarct due to large vesselocclusion treated with intravenous thrombolysis and mechani-cal thrombectomy had comparable outcomes to those treatedwith mechanical thrombectomy alone.Disclosures M. Anadani: None. A. Shaban: None. S. AlKasab: None. R. Chalhoub: None. I. Maier: None. M. Psy-chogios: None. A. Alaweih: None. S. Wolfe: None. A.Authur: None. T. Dumont: None. P. Kan: None. J. Kim:None. R. De Leacy: None. J. Osbun: None. A. Rai: None. P.Jabbour: None. M. Park: None. J. Mascitelli: None. M. Lev-itt: None. A. Polifka: None. W. Casagranda: None. S. Yoshi-mura: None. C. Matouk: None. R. Williamson: None. B.Gory: None. M. Mokin: None. I. Fragata: None. D.Romano: None. S. Chowdry: None. M. Moss: None. D.Behme: None. K. Limaye: None. A. Spiotta: None. E. Sama-niego: None.O-070 DIRECT TO CT/ANGIO – A METROPOLITAN SINGLECENTER EXPERIENCE WITH SUBSTANTIALLY DECREASEDTIME TO THROMBECTOMYN Siddiqui*, R De Leacy. Mount Sinai Hospital, New York, NY10.1136/neurintsurg-2022-SNIS.70Introduction/Purpose In the setting of ischemic stroke, rapidrecanalization is associated with higher likelihood of func-tional independence. Patients undergoing reperfusion withinthe first 2.5 hours of symptom onset show a 91% rate offunctionally independent outcome.1 Optimizing outcomes inpatients undergoing mechanical thrombectomy requires fastworkflow, and several models have been proposed todecrease time. Our study outlines time outcomes in a directto angio suite model in which the angio suite is directlyaccessible and contains a room with combined angio/CT, thusbypassing the emergency department. These outcomes arecompared to a traditional pathway that does involve evalua-tion in the emergency room.Materials and Methods Data on 152 strokes arriving to a sin-gle site from years 2017–2022 was collected. A total of 141of these were intervened upon for an endovascular thrombec-tomy. Procedural times were recorded, including time ofarrival, time from arrival to patient arrival in angio suite (‘IRarrival’), time from IR arrival to groin puncture (GP), andtime of recanalization to a score of TICI 2B or higher.Results A total of 152 patients with 141 thrombectomies wererouted in a single metropolitan center over the course of 4years. Those encompassing the traditional pathway tookapproximately 146 minutes from arrival to TICI 2B recanali-zation time, while those in direct to angio took 87 minutes(p<0.0001). Figure 1 outlines time metric comparisonbetween traditional and direct to angio pathways. Table 1 out-lines this breakdown based on transfer status, a well-knownimpediment to timely recanalization. There was no significantdifference in recanalization time for transfer patients in termsof timing, regardless of the pathway taken (traditional vsAbstractsJ NeuroIntervent Surg 2022;14(Suppl 1):A1–A248 A45by copyright. on July 29, 2022 at University of South Dakota. Protectedhttp://jnis.bmj.com/J NeuroIntervent Surg: first published as 10.1136/neurintsurg-2022-SNIS.68 on 23 July 2022. Downloaded from 

Direct mechanical thrombectomy with or without bridging thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials

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Direct mechanical thrombectomy with or without bridging thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials

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