IV Thrombolysis Before Thrombectomy in Carotid Artery Dissection–Related Large-Vessel Occlusion

BACKGROUND AND OBJECTIVES: The benefit of IV thrombolysis (IVT) before thrombectomy in patients with anterior-circulation large-vessel occlusion (LVO) due to carotid artery dissection (CAD) remains uncertain. We aimed to evaluate the safety and efficacy of IVT in this specific population in clinical practice. METHODS: This study included patients from the Carotid Dissection Thrombectomy vs Medical Treatment collaboration and the Endovascular Treatment in Ischemic Stroke registry with anterior-circulation LVO due to CAD who were treated with thrombectomy, with or without prior IVT. The coprimary outcomes were favorable functional outcome at 3 months (modified Rankin Scale 0-2) and successful reperfusion (thrombolysis in cerebral infarction score ≥2b). The safety end point was symptomatic intracranial hemorrhage (sICH). Inverse probability of treatment weighting was applied to adjust for baseline imbalances, and weighted Poisson regression models were used to estimate adjusted risk ratios (aRRs). RESULTS: interaction = 0.039). DISCUSSION: IVT prior thrombectomy was associated with improved functional outcome and higher reperfusion success in patients with anterior-circulation LVO due to CAD, without an increase in sICH. The association with functional outcome was largely driven by patients presenting with higher admission stroke severity. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT before thrombectomy was associated with improved functional outcome and higher reperfusion success in patients with anterior-circulation LVO due to CAD, without an increase in sICH.

Authors

Institutions

Publication Details

Journal
Neurology
Published
2026-05-27
DOI
https://doi.org/10.1212/wnl.0000000000218125
Primary Topic
Intracranial Aneurysms: Treatment and Complications
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

IV Thrombolysis Before Thrombectomy in Carotid Artery Dissection–Related Large-Vessel Occlusion

Joshua Mbroh, Florian Hennersdorf, Benjamin Bender, Julian Frederic Hotz et al.
Neurology
Intracranial Aneurysms: Treatment and Complications
article

IV Thrombolysis Before Thrombectomy in Carotid Artery Dissection–Related Large-Vessel Occlusion

Joshua Mbroh, Florian Hennersdorf, Benjamin Bender, Julian Frederic Hotz, E Gizewski, Michail Panagiotis Giannakakis, Dominika Miksova, Hannes A. Deutschmann, Igor Sibon, Sven Poli, Valerie Wolff, Bertrand Lapergue, Guillaume Saliou, Lisa Kaindl, for the CONCORDIA investigators and ETIS investigators, Benjamin Gory, Johannes Kaesmacher, Christian H. Nolte, Sebastien Richard, Marek Sykora, Arturo Consoli, Jens Fiehler, Joachim Fladt, Urs Fischer, Raoul Pop, Zsolt Kulcsár, Gaultier Marnat
article en

Abstract

BACKGROUND AND OBJECTIVES: The benefit of IV thrombolysis (IVT) before thrombectomy in patients with anterior-circulation large-vessel occlusion (LVO) due to carotid artery dissection (CAD) remains uncertain. We aimed to evaluate the safety and efficacy of IVT in this specific population in clinical practice. METHODS: This study included patients from the Carotid Dissection Thrombectomy vs Medical Treatment collaboration and the Endovascular Treatment in Ischemic Stroke registry with anterior-circulation LVO due to CAD who were treated with thrombectomy, with or without prior IVT. The coprimary outcomes were favorable functional outcome at 3 months (modified Rankin Scale 0-2) and successful reperfusion (thrombolysis in cerebral infarction score ≥2b). The safety end point was symptomatic intracranial hemorrhage (sICH). Inverse probability of treatment weighting was applied to adjust for baseline imbalances, and weighted Poisson regression models were used to estimate adjusted risk ratios (aRRs). RESULTS: interaction = 0.039). DISCUSSION: IVT prior thrombectomy was associated with improved functional outcome and higher reperfusion success in patients with anterior-circulation LVO due to CAD, without an increase in sICH. The association with functional outcome was largely driven by patients presenting with higher admission stroke severity. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT before thrombectomy was associated with improved functional outcome and higher reperfusion success in patients with anterior-circulation LVO due to CAD, without an increase in sICH.

NeurologyVol. 106(12)
Sigmund Freud Privatuniversität Wien (AT), St. John's Hospital (US), Innsbruck Medical University (AT), Université de Bordeaux (FR), Inserm (FR), Universität Hamburg (DE), Medical University of Graz (AT), University Hospital of Bern (CH), University Hospital of Basel (CH), Centre Hospitalier Régional et Universitaire de Nancy (FR), University Hospital of Zurich (CH), Bordeaux Population Health (FR), Imagerie Adaptative Diagnostique et Interventionnelle (FR), Gesundheit Österreich (AT), University Children's Hospital Tübingen (DE), Hertie Institute for Clinical Brain Research (DE), Hôpital Foch (FR), Université de Strasbourg (FR), Medical University of Vienna (AT), Charité - Universitätsmedizin Berlin (DE), University of Tübingen (DE), Université de Lorraine (FR), University of Lausanne (CH)
Openalex Percentile: Top 6%
Intracranial Aneurysms: Treatment and Complications
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.