Since there seems to be no protocol on how to treat strokes you will need to ask your stroke hospital EXACTLY THE FORM OF STROKE TO HAVE TO BE TREATED PROPERLY. Your responsibility is to match your stroke with what your stroke hospital can handle. Not the other way around where your stroke hospital competently handles all types of strokes. Good luck with that.
Intravenous Thrombolysis before Thrombectomy may Increase the Incidence of Intracranial Hemorrhage inTreating Carotid T Occlusion
Published:December 01, 2020DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105473
Abstract
Background and Purpose
Current evidence does not agree on the merits of direct and bridging thrombectomy.
This study aimed to compare the safety and efficacy of direct thrombectomy (DT) and
bridging thrombectomy (BT) in treating patients with acute ischaemic stroke due to
carotid T occlusion.
Methods
Patients with stroke due to carotid T occlusion who were treated with DT or BT were
retrospectively collected from four advanced stroke centres. Baseline characteristics
and clinical outcomes were compared between the groups. Successful recanalization
was defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2b
or 3. A favourable outcome was defined by a modified Rankin Scale (mRS) score of 0–2
at 90 days after stroke onset(tyranny of low expectations here, this is NOT GOOD ENOUGH). Multivariable analysis was performed to control for
potential confounders.
Results
Of the 111 enrolled patients, 57 (51.4%) patients were treated with DT, and 54 (48.6%)
were treated with BT. Patients treated with DT had a shorter imaging to puncture (ITP)
time (53 min versus 92 min, P<0.001) and symptom onset to puncture (OTP) time (198
min versus 218 min,
P=0.045) than patients treated with BT. No significant difference was detected concerning
the rate of successful recanalization (80.7% versus 77.8%,
P=0.704) or a favourable outcome between patients treated with DT and BT (35.1% versus
33.3%,
P=0.846). Patients treated with DT had a lower intracranial haemorrhage (ICH) rate
(40.4% versus 59.3%,
P=0.046), but the difference was not significant for symptomatic ICH (sICH, 12.3% versus
16.7%,
P=0.511) or asymptomatic ICH (aICH, 28.1% versus 42.6%,
P=0.109). After adjusting for potential confounding factors, the ratio of favorable
prognosis, successful reperfusion, sICH and mortality did not differ between the two
groups. However, there was a higher rate of ICH (OR=2.492, 95% CI 1.005 to 6.180,
p=0.049) in the BT group as compared with the DT group.
Conclusions
DT seems equivalent to BT in treating stroke due to carotid T occlusion in favorable
outcome, successful recanalization, 90-day morality and sICH. However, BT may increase
the incidence of ICH in this specific type stroke.
Key Words
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