IV Thrombolysis Before Thrombectomy in Carotid Artery Dissection–Related Large-Vessel Occlusion
Year: 2026
Type: article
Study design: Observational Study
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.
Source: Neurology
Authors: Julian Frederic Hotz, Sven Poli, Michail Panagiotis Giannakakis, Lisa Kaindl, Dominika Miksova, Joachim Fladt, Johannes Kaesmacher, Zsolt Kulcsár, Guillaume Saliou, Sebastien Richard, Gaultier Marnat, Igor Sibon, Raoul Pop, Valerie Wolff, Arturo Consoli, Joshua Mbroh, Florian Hennersdorf, Benjamin Bender, Jens Fiehler, Hannes A. Deutschmann, Elke R. Gizewski, Christian H. Nolte, Urs Fischer, Bertrand Lapergue, Benjamin Gory, Marek Sykora, for the CONCORDIA investigators and ETIS investigators
Institutions: University of Bern, University Hospital of Bern, Medical University of Vienna, Universitätsklinikum Tübingen, Hertie Institute for Clinical Brain Research, University of Tübingen, University Hospital of Basel, University Hospital Zurich, Centre Hospitalier Universitaire Vaudois, Inserm, Défaillance Cardiovasculaire Aiguë et Chronique, Université de Lorraine, Centre Hospitalier Universitaire de Bordeaux, Hôpitaux Universitaires de Strasbourg, Hôpital Foch, Universität Hamburg, University of Graz, Medical University of Graz, Innsbruck Medical University, Universität Innsbruck, Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Centre Hospitalier Régional et Universitaire de Nancy, Imagerie Adaptative Diagnostique et Interventionnelle, Sigmund Freud Privatuniversität Wien
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7162511322