Results of primary endovascular treatment compared to endovascular treatment combined with intravenous thrombolysis in patients with stroke

The study objective is to investigate immediate angiographic and clinical results of endovascular treatment of ischemic stroke in patients who had contraindications to the appointment of adjuvant thrombolytic therapy (TLT), and patients who underwent combined treatment (TLT + thrombolysis/thrombextraction).

Materials and methods. From 2016 to 2018, selective cerebral arteriography was performed in 48 patients with acute stroke within 4.5 hours from the onset of the disease to ascertain the possibility of endovascular treatment. The main indication was occlusion of a large intracranial vessel (internal carotid artery or middle cerebral artery at the level of M1–M2 segments) according to multislice computed tomography. In the absence of contraindications, TLT was prescribed and selective angiography and thrombaspiration/thrombextraction were performed. In 5 (10.4 %) patients with TLT no occlusion of the intracranial vessel was found, it was interpreted as evidence of effectiveness, these patients were excluded from further analysis.

Results. The group of combined treatment (TLT + endovascular procedure) included 18 patients, the group of endovascular treatment without TLT – 25. The severity of stroke in patients who were denied TLT was objectively heavier, which led to a statistically worse prognosis than in patients who were assigned TLT. However, after the endovascular procedure (which was more successful according to a number of indirect criteria), the clinical characteristics of both groups were similar. In patients undergoing endovascular intervention without TLT, thrombaspiration often proved to be an effective, rarely used expensive tools to thrombextraction, decreased the number of attempts of thrombextraction using a stent retriever and there were rare cases of embolization of the distal territory.

Conclusion. If it is possible to perform endovascular intervention without TLT and without additional time spent on transportation, it can be a method of choice, providing equal or possibly greater efficacy and safety of treatment in comparison with TLT. Further experience and further research is needed to clarify the value of both methods.

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