Comparison of mechanical thrombectomy alone versus post-IV t-PA thrombectomy in acute large artery occlusion within 4.5 hours of symptom onset

Q: What was the main objective of the study?

To compare clinical and radiological outcomes of mechanical thrombectomy (MT) only versus MT after full IV t-PA administration within 4.5 hours of symptom onset.

Q: How were patients selected and what were the comparison groups?

A retrospective review included 190 patients treated with MT from January 2018 to December 2020; after excluding 53 ineligible for IV t-PA, 137 patients were analyzed as MT only (n=82) versus post-IV t-PA MT (n=55).

Q: Did successful recanalization and 90-day functional outcomes differ between groups?

No. Successful recanalization rates and good clinical outcomes at 90 days were not statistically different between MT-only and post-IV t-PA MT groups.

Sep 28, 2026

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Intravenous tissue plasminogen activator (IV t-PA) is commonly used as bridging therapy before mechanical thrombectomy (MT), yet some patients receive MT only after full IV t-PA administration. This retrospective study compared clinical and radiological outcomes of MT-only versus post-IV t-PA MT in acute large artery occlusion within 4.5 hours of symptom onset. Among 137 eligible patients, successful recanalization and 90-day functional outcomes were not significantly different between groups, while baseline NIHSS and door-to-puncture time predicted outcome.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Objective

Methods

Patients and treatment groups

Outcomes

Results

Conclusions

Clinical Article Journal of Cerebrovascular Endovascular Neurosurgery and Journal of Cerebrovascular and Endovascular Neurosurgery pISSN 2234-8565, eISSN 2287-3139, [https://doi.org/10.7461/jcen.2025.E2025.04.004](https://doi.org/10.7461/jcen.2025.E2025.04.004) Comparison of mechanical thrombectomy alone versus post-IV t-PAthrombectomy in acute large artery occlusion within 4.5 hours of symptom onset Joonwon Lee1, Hyungon Lee2*, Kyung-wan Kim3, Seung Hwan Kim4, Yunhyeok Choi5, Sung-Chul Jin6 1Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea 2Department of Neurosurgery, Haeundae Bumin Hospital, Busan, Republic of Korea 3Department of Radiology, Masan University, Changwon, Republic of Korea 4Department of Neurosurgery, Samsung Changwon Hospital Sungkyunkwan University School of Medicine, Changwon, Republic of Korea 5Department of Neurosurgery, GoodSamsun Hospital, Busan, Republic of Korea 6Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea | J Cerebrovasc Endovasc Neurosurg. 2025 December;27(4):318-326
Received: 2 April 2025
Revised: 7 July 2025
Accepted: 11 July 2025 | | --- | | Correspondence to
Sung-Chul Jin
Department of Neurosurgery, Inje University Haeundae Paik Hospital, 875, Haeun-daero, Haeundae-gu, Busan 48108, Republic of Korea
Tel +82-51-797-0607 Fax +82-51-797-0434
E-mail [kusmal@hanmail.net](kusmal@hanmail.net)
ORCID [https://orcid.org/0000-0001-5282-9329](https://orcid.org/0000-0001-5282-9329) | * equally contributed as first author This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective: Intravenous tissue plasminogen activator (IV t-PA) is commonly used as bridging therapy before mechanical thrombectomy (MT) in acute ischemic stroke. However, in practice, some patients undergo MT only after IV t-PA has been fully administered. This study aimed to compare clinical and radiological outcomes of MT only versus IV t-PA followed by MT within 4.5 hours of symptom onset. Methods: We retrospectively reviewed 190 patients with acute large artery occlusion treated with MT between January 2018 and December 2020. After excluding 53 patients ineligible for IV t-PA. A total of 137 patients were enrolled and categorized into two groups: MT only (n=82, 59 .8%) and post-IV t-PA MT (n=55, 40 .2%) . The primary outcome was successful recanalization; the secondary outcome was a good clinical outcome at 90 days (3-month modified Rankin Scale (mRS) score of 0–2) . Results: The successful recanalization rates did not significantly differ between the MT-only and post-IV t-PA MT groups (92 .7% vs. 89. 1%, p=0 .466) . Good outcomesat 90 days were not statistically different between both groups (58 . 5% vs. 61. 8%, p=0 .701) . Multivariable analysis identified baseline National Institutes of Health Stroke Scale (NIHSS) score (adjusted odds ratio (OR) 0. 873; 95% confidence intervals (CI), 0.806–0. 946; p<0 . 001) and door-to-puncture time (adjusted OR 0.987; 95% CI, 0.978–0.997; p=0 . 009) as independent predictors of outcome. Conclusions: In our study, MT alone yielded comparable outcomes to IV t-PA followed by MT in patients treated within 4.5 hours. Direct MT may be a reasonable treatment strategy. Keywords Tissue plasminogen activator, Thrombectomy, Treatment outcome, Recanalization 318 [www.the-jcen.org](www.the-jcen.org) Copyright © 2025 by KSCVS and KoNES INTRODUCTION Intravenous tissue plasminogen activator (IV t-PA) alone has been reported to achieve a successful recanalization rate of approximately 50% . 11) In contrast, mechanical thrombe

FAQs

What was the main objective of the study?

To compare clinical and radiological outcomes of mechanical thrombectomy (MT) only versus MT after full IV t-PA administration within 4.5 hours of symptom onset.

How were patients selected and what were the comparison groups?

A retrospective review included 190 patients treated with MT from January 2018 to December 2020; after excluding 53 ineligible for IV t-PA, 137 patients were analyzed as MT only (n=82) versus post-IV t-PA MT (n=55).

Did successful recanalization and 90-day functional outcomes differ between groups?

No. Successful recanalization rates and good clinical outcomes at 90 days were not statistically different between MT-only and post-IV t-PA MT groups.

Sep 28, 2026

Uploaded by McQueen