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Background anticoagulated patients (APS) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPa); however, these patients could benefit from mechanical thrombectomy (MT). evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs. Methods We analyzed three patient groups from two prospective registries: aPs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with iV-rtPa and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified rankin scale (mrs) ≤2 and safety (radiologic intracranial hemorrhage (rich), symptomatic intracranial hemorrhage (sich) and death rate at 3 months) between groups. results 333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the naP-MT group and NAPIVTMT groups, respectively. Multivariate analysis showed that the aP-MT group had a lower risk of rich (Or 2.77, 95% ci 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (Or 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the naP-iVTMT group. no difference was found between the AP-MT and NAP-MT groups. Conclusions With regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. however, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group. [ABSTRACT FROM AUTHOR]

Introduction Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. Objective To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT). Material and methods Patients with ICA-O treated with MT alone or BT were retrospectively examined and compared. Demographic data, vascular risk factors, treatment modalities, complications, technical and clinical outcomes were recorded. A propensity score (PS) analysis was used to compare modified Rankin Scale (mRS) score at 3 months and intracerebral hemorrhage (ICH) between groups. Results 141 consecutive patients (60% BT/40% MT) were included between January 2014 and June 2016. Baseline characteristics did not differ between the groups. There was no significant difference in the rate of Thrombolysis in Cerebral Infarction 2b/3, distal emboli, and median number of passes between the groups. There was a significant difference between BT and MT groups in the median time between imaging and groin puncture (median 97 min vs 75, p=0.007), the rate of ICH (44% vs 27%, p=0.05), but not for symptomatic ICH (18% vs 13%, p=0.49). With PS, there was a trend towards a higher rate of ICH (OR=2.3, 95% CI 0.9 to 5.9, p=0.09) in the BT group compared with the MT alone group, with no difference in mRS score ≤2 at 3 months (OR=1.6, 95% CI 0.7 to 3.7, p=0.29). Conclusion There was no significant difference in clinical outcomes between patients receiving bridging therapy versus direct thrombectomy. Bridging therapy delayed time to groin puncture and increased ICH rate. [ABSTRACT FROM AUTHOR]