Early recanalization with intravenous thrombolysis before mechanical thrombectomy: considerations to explore with tenecteplase

Time is brain. Hence, timely reperfusion in emergent large vessel occlusion (LVO) stroke is critical for favorable outcomes. Intravenous thrombolysis with alteplase (TPA) before mechanical thrombectomy (MT) for emergent LVO stroke is associated with significantly higher rates of preinterventional reperfusion than MT alone. Recent post hoc analyses of SWIFT-DIRECT and DIRECT-MT have shown that times longer than 30 min since TPA administration are associated with increased reperfusion rates.1 2 The incremental increase of reperfusion rates with longer times since TPA administration underpins TPA’s time dependence to exert clot dissolution in emergent LVO strokes.3 4 Distinct clot characteristics, such as shorter thrombus length, more distal location in the anterior circulation, and lesser clot burden (ie, higher clot burden score), have been associated with clot susceptibility to TPA-lysis and hence reperfusion rates.5 6 Overall, reperfusion rates before MT with and...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Letter Source Type: research