{
  "abstract": "Background The impact of intravenous (IV) thrombolysis on the outcomes of aspiration thrombectomy as the primary endovascular approach to stroke in patients with large vessel occlusion is unknown.Methods The Imperative Trial was a prospective, investigational device exemption, multicenter trial of first-line aspiration thrombectomy that assessed the safety and efficacy of the Zoom System, including a novel 0.088 inch aspiration catheter in patients with stroke within 8 hours of onset. We compared procedural, technical, and clinical outcomes of aspiration thrombectomy based on whether patients had received IV thrombolytics prior to the intervention.Results Among the 260 patients treated with front-line aspiration thrombectomy using the Zoom System, 125 (48%) received IV thrombolysis prior to aspiration. Rates of modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b achieved with the Zoom System were higher in the aspiration-only group than in the combined group (92% vs 81%, P=0.016). Rates of mTICI ≥2c and first pass effect were similar. The use of rescue devices to achieve mTICI ≥2b was less frequent in the aspiration-only group than in the combined group (2% vs 10%, P=0.008). The rates of functional independence (modified Rankin Scale (mRS) score 0–2) in the aspiration-only group and the combined group were 50% and 59%, respectively (P=0.16). Univariate (P=0.30) and multivariate (P=0.47) ordinal regression analyses showed no significant correlation of mRS 0–2 with IV thrombolysis. Both groups had similar safety outcomes including rates of symptomatic intracranial hemorrhage and 90-day mortality.Conclusions Aspiration thrombectomy alone may result in higher rates of successful reperfusion and reduce the need for rescue devices compared with the combined approach with IV thrombolysis.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Brain and Spine, University of South Florida College of Medicine, Tampa General Hospital, Tampa, Florida, USA"
      ],
      "name": "Maxim Mokin"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Reade Andrew De Leacy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, California, USA",
        "Department of Neurosurgery, University of Southern California, Los Angeles, California, USA"
      ],
      "name": "William Mack"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Stroke Institute, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Raul G Nogueira"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Shahram Majidi"
    },
    {
      "affiliations": [
        "Department of Radiology, Huntsville Hospital, Huntsville, Alabama, USA"
      ],
      "name": "Robert Dana Tomalty"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA"
      ],
      "name": "Jan Vargas"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Brett L Cucchiara"
    },
    {
      "affiliations": [
        "Department of Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA",
        "Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA"
      ],
      "name": "Kenneth V Snyder"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA"
      ],
      "name": "Justin Mascitelli"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA"
      ],
      "name": "Victoria Parada"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"
      ],
      "name": "Hakeem J Shakir"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Munson Medical Center, Traverse City, Michigan, USA"
      ],
      "name": "David Rosenbaum-Halevi"
    },
    {
      "affiliations": [
        "Lyerly Neurosurgery, Baptist Health System, Jacksonville, Florida, USA"
      ],
      "name": "Amin Aghaebrahim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Tennessee, Memphis, Tennessee, USA"
      ],
      "name": "Daniel Hoit"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, John Muir Health, Walnut Creek, California, USA"
      ],
      "name": "Benjamin Yim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Southern California, Los Angeles, California, USA"
      ],
      "name": "Matthew S Tenser"
    },
    {
      "affiliations": [
        "Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center Stroke Institute, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Alhamza R Al-Bayati"
    },
    {
      "affiliations": [
        "Department of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA"
      ],
      "name": "James M Milburn"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Ohio State University, Columbus, Ohio, USA"
      ],
      "name": "Shahid M Nimjee"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montefiore Hospital and Medical Center, Bronx, New York, USA"
      ],
      "name": "Neil Haranhalli"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA"
      ],
      "name": "Michael Nahhas"
    },
    {
      "affiliations": [
        "Department of Neurointerventional Radiology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA"
      ],
      "name": "Darryn Shaff"
    },
    {
      "affiliations": [
        "Department of Neuro Endovascular Surgery, Baylor University Medical Center, Dallas, Texas, USA"
      ],
      "name": "Kennith F Layton"
    },
    {
      "affiliations": [
        "Department of Neurosurgery Tallahassee Memorial Hospital, Florida State University, Tallahassee, Florida, USA"
      ],
      "name": "Narlin Beaty"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA"
      ],
      "name": "Harris Hawk"
    },
    {
      "affiliations": [
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Diogo C Haussen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Emory University Scchool of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Aqueel Pabaney"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Christopher Paul Kellner"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Jonathan A Grossberg"
    }
  ],
  "title": "Impact of intravenous thrombolysis on aspiration thrombectomy outcomes: an Imperative Trial subgroup analysis",
  "uid": "760def4f-8821-501c-99d1-a20dc5091a27"
}