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Does Intravenous Thrombolysis Within 4.5 to 9 Hours Increase Clot Migration Leading to Endovascular Inaccessibility?

Authors :
Lim JC
Churilov L
Bivard A
Ma H
Dowling RJ
Campbell BCV
Parsons MW
Davis SM
Donnan GA
Mitchell PJ
Yan B
Source :
Stroke [Stroke] 2021 Mar; Vol. 52 (3), pp. 1083-1086. Date of Electronic Publication: 2021 Feb 16.
Publication Year :
2021

Abstract

Background and Purpose: Distal clot migration is a recognized event following intravenous thrombolysis (IVT) in the setting of acute ischemic stroke. Of note, clots that were initially retrievable by endovascular thrombectomy may migrate to a distal nonretrievable location and compromise clinical outcome. We investigated the incidence of clot migration leading to clot inaccessibility following IVT in the time window of 4.5 to 9 hours.<br />Methods: We performed a retrospective analysis of the EXTEND trial (Extending the Time for Thrombolysis in Emergency Neurological Deficits) data. Baseline and 12- to 24-hour follow-up clot location was determined on computed tomography angiogram or magnetic resonance angiogram. The incidence of clot migration leading to a change from retrievable to nonretrievable location was identified and compared between the two treatment groups (IVT versus placebo).<br />Results: Two hundred twenty patients were assessed. Clot migration from a retrievable to nonretrievable location occurred in 37 patients: 21 patients (19.3%) in the placebo group and 16 patients (14.4%) in the IVT group. No significant difference was identified in the incidence of clot migration leading to inaccessibility between groups ( P =0.336).<br />Conclusions: Our results did not show increased clot migration leading to clot inaccessibility in patients treated with IVT.

Details

Language :
English
ISSN :
1524-4628
Volume :
52
Issue :
3
Database :
MEDLINE
Journal :
Stroke
Publication Type :
Academic Journal
Accession number :
33588590
Full Text :
https://doi.org/10.1161/STROKEAHA.120.030661