Intravenous thrombolysis prior to endovascular treatment in posterior circulation occlusions; a MR CLEAN Registry study.

Background and aimsThe effectiveness of intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT prior to EVT in posterior circulation occlusions in a nationwide registry. MethodsPatients were included from the MR CLEAN Registry: a nationwide, prospective, multicenter registry of patients with acute ischemic stroke (AIS) due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift towards better functional outcome on the modified Rankin scale (mRS) at 90 days. Secondary outcomes were favorable functional outcome (mRS 0-3), occurrence of symptomatic intracranial hemorrhages (sICH), successful reperfusion (eTICI[≥]2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariate analyses and literature were applied. ResultsA total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) prior to EVT. Results show no differences in a shift on the mRS (acOR:1.04, 95%CI:0.61-1.76). Although sICH occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (aOR:1.65, 95%CI:0.33-8.35). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. ConclusionsWe found no significant differences in clinical, technical and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT prior to endovascular therapy. Our results are in line with the literature on the anterior circulation.