Safety and Efficacy of Combined Thrombolysis and Thrombectomy in the Extended Time Window of Acute Ischemic Stroke

Abstract Background Endovascular thrombectomy (EVT) is the standard of care for proximal anterior circulation acute ischemic stroke. (1) Treatment with intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT), known as bridging therapy, is recommended for candidate patients within 4.5 hours therapeutic window. (2) Updated guidelines from the American Stroke Association extended the time limit of mechanical clot removal from 6 hours to up to 24 hours in selected patients . (3) In this study, we plan to focus on treatment with intravenous thrombolytic therapy prior to endovascular thrombectomy in the extended time window beyond 4.5 hours with safety and efficacy concerns. Methods 50 large vessel occlusion (LVO) stroke patients presenting in the extended time window of 4.5-9 hours were enrolled in the study divided into two groups, the first received IV thrombolysis before mechanical thrombectomy, the 2nd underwent mechanical thrombectomy only. Assessment was done using NIHSS, mRS, collaterals score, Thrombolysis In Cerebral Ischemia (TICI) score, and Heidelberg bleeding classification for hemorrhagic transformation. Results there was difference between the two groups regarding NIHSS, mRS, first pass effect and hemorrhagic transformation. Conclusion IV thrombolysis before mechanical thrombectomy can have an effect on outcome of LVO stroke patients presenting in the extended time window.