{
  "abstract": "Background Whether intravenous thrombolysis (IVT) should be administered prior to endovascular therapy (EVT) in patients with atherothrombotic stroke-related large vessel occlusion (AT-LVO) remains unclear. This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO. Patients were categorised based on presumed mechanism of occlusion: in situ occlusion (intracranial group) or embolism from cervical artery occlusion/stenosis (tandem group). We compared the efficacy and safety of IVT before EVT in patients who received IVT (IVT stratum) and those who did not (non-IVT stratum). The primary outcome was a modified Rankin Scale score of 0–2 at 90 days.Results Among the 336 patients in the intracranial group, 99 patients underwent IVT. The rate of favourable functional outcomes did not differ between IVT and non-IVT strata (51.1% vs 47.6%; adjusted ORs (aORs) (95% CI), 1.18 (0.66 to 2.09)); whereas any intracranial haemorrhage (ICH) (10.1% vs 3.8%; aOR, 2.98 (1.01 to 9.26)) and mortality at 90 days (6.4% vs 1.3%; aOR, 4.66 (1.02 to 26.73)) were significantly higher in the IVT stratum. Among the 233 patients in the tandem group, 88 patients underwent IVT, with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO, IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion. IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan",
        "Department of Neurology, Kumamoto University, Kumamoto, Kumamoto Prefecture, Japan"
      ],
      "name": "Hirotaka Hayashi"
    },
    {
      "affiliations": [
        "Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Kumamoto, Japan"
      ],
      "name": "Satoshi Namitome"
    },
    {
      "affiliations": [
        "Department of Neurology, Kumamoto University, Kumamoto, Kumamoto Prefecture, Japan"
      ],
      "name": "Seigo Shindo"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Shinichi Yoshimura"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Manabu Shirakawa"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan",
        "Department of Neurosurgery, Osakafu Saiseikai Noe Hospital, Osaka, Osaka Prefecture, Japan"
      ],
      "name": "Mikiya Beppu"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Seijinkai Shizunai Hospital, Hidaka District, Hokkaido Prefecture, Japan"
      ],
      "name": "Nobuyuki Sakai"
    },
    {
      "affiliations": [
        "Division of Stroke and Treatment, institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan"
      ],
      "name": "Hiroshi Yamagami"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Kazutaka Uchida"
    },
    {
      "affiliations": [
        "Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka Prefecture, Japan"
      ],
      "name": "Kazunori Toyoda"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan"
      ],
      "name": "Yuji Matsumaru"
    },
    {
      "affiliations": [
        "Division of Department and Discovery of Intervention Therapy, Tohoku University, Sendai, Miyagi Prefecture, Japan"
      ],
      "name": "Yasushi Matsumoto"
    },
    {
      "affiliations": [
        "Department of Neurology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan"
      ],
      "name": "Kenichi Todo"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan"
      ],
      "name": "Mikito Hayakawa"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Ota Memorial Hospital, Ota, Gunma Prefecture, Japan"
      ],
      "name": "Shinzo Ota"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Kanagawa Prefecture, Japan"
      ],
      "name": "Masafumi Morimoto"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Seisho Hospital, Odawara, Kanagawa Prefecture, Japan"
      ],
      "name": "Masataka Takeuchi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka Prefecture, Japan"
      ],
      "name": "Hirotoshi Imamura"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, Japan"
      ],
      "name": "Hiroyuki Ikeda"
    },
    {
      "affiliations": [
        "Stroke Center, Kindai University Hospital, Osakasayama, Osaka Prefecture, Japan"
      ],
      "name": "Kanta Tanaka"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan"
      ],
      "name": "Hideyuki Ishihara"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Iryo Hojin Seijinkai Shimizu Byoin, Kyoto, Kyoto Prefecture, Japan"
      ],
      "name": "Hiroto Kakita"
    },
    {
      "affiliations": [
        "Deapartment of Neurosurgery, Ise Red Cross Hospital, Ise, Mie Prefecture, Japan"
      ],
      "name": "Takanori Sano"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan"
      ],
      "name": "Hayato Araki"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Okawara Neurosurgical Hospital, Muroran, Hokkaido Prefecture, Japan"
      ],
      "name": "Tatsufumi Nomura"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo Prefecture, Japan"
      ],
      "name": "Fumihiro Sakakibara"
    },
    {
      "affiliations": [
        "Department of Neurology, Kumamoto University, Kumamoto, Kumamoto Prefecture, Japan"
      ],
      "name": "Mitsuharu Ueda"
    },
    {
      "affiliations": [
        "Department of Neurology, Kumamoto University, Kumamoto, Kumamoto Prefecture, Japan"
      ],
      "name": "Makoto Nakajima"
    }
  ],
  "title": "Effect of intravenous alteplase before endovascular therapy for atherothrombotic stroke-related large vessel occlusion: subanalysis of the RESCUE AT-LVO registry",
  "uid": "04928228-a6ce-5322-9d48-507e7efe72be"
}