Abstract Body: Background and Purpose: Intra-arterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intra-arterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.
Methods: We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans. We determined the risk of ICH in subgroups defined by clinical characteristics, and use of intravenous (IV) thrombolysis.
Results: A total of 146 (7.5%) patients received intra-thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intra-arterial thrombolysis (p=0.006). Among patients who received IV thrombolysis (n=1042), the proportion of patients who developed ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intra-arterial thrombolysis (p=0.028). The risk was not different in strata defined by age, gender, location of occlusion, pre-procedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT score, systolic blood pressure, and serum glucose concentrations.
Conclusions: In patients undergoing mechanical thrombectomy, the risk of any ICH and sICH was not increased with intra-arterial thrombolysis, including in those who had already received IV thrombolytics.