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Supplementary Material for: Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy

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posted on 20.04.2017 by Park H.-K., Chung J.-W., Hong J.-H., Jang M.U., Noh H.-D., Park J.-M., Kang K., Lee S.J., Ko Y., Kim J.G., Cha J.-K., Kim D.-H., Nah H.-W., Han M.-K., Kim B.J., Park T.H., Park S.-S., Lee K.B., Lee J., Hong K.-S., Cho Y.-J., Lee B.-C., Yu K.-H., Oh M.S., Cho K.-H., Kim J.-T., Kim D.-E., Ryu W.-S., Choi J.C., Kim W.-J., Shin D.-I., Yeo M.-J., Sohn S.-I., Lee J.S., Yoon B.-W., Bae H.-J.

Background: The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. Methods: From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios (ORs) of preceding IVT. Results: Of the 639 patients (male, 61%; age 69 ± 12; National Institutes of Health Stroke Scale score of 15 [11-19]) who met the eligibility criteria, 458 received preceding IVT. These patients showed lower mRS scores (adjusted common OR, 1.38 [95% CI 0.98-1.96]). Preceding IVT was associated with successful recanalization (1.96 [1.23-3.11]) and reduced 3-month mortality (0.58 [0.35-0.97]) but not with SHT (0.96 [0.48-1.93]). Conclusion: In patients treated with EVT within 8 of acute ischemic stroke onset, preceding IVT may enhance survival and successful recanalization without additional risk of SHT, and mitigate disability at 3 months.

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