Mechanical Thrombectomy Outcomes With or Without Intravenous Thrombolysis Insight From the ASTER Randomized Trial |
ASTER Trial Investigators |
Post hoc analysis of the ASTER trial. The primary outcome was favorable 90-day functional outcome defined as a mRS of
≤2. Secondary outcomes were successful reperfusion following all procedures and after the first-line procedure, number
of device passes, and change in National Institutes of Health Stroke Scale score at 24 hours. Safety outcomes included
90-day mortality and any symptomatic intracerebral hemorrhage. |
381 pts, 250 IVT before MT (IVT+MT group). No significant differences between IVT+MT and MT-alone groups in 90-day favorable functional outcome or TICI score or NIHSS at 24h. The 90-day mortality rate in the IVT+MT group was lower than after MT alone. In a subgroup of patients without anticoagulant medication before stroke onset, we observed in the IVT+MT group a better functional
outcome (fully-adjusted risk ratio, 1.38; 95% CI, 1.02–1.89), a higher successful recanalization rate after first-line strategy (fully-adjusted risk ratio, 1.26; 95% CI, 1.05–1.50), and a lower mortality rate (fully-adjusted risk ratio, 0.58. Conclusions—Our results show that IVT+MT patients in the ASTER trial have lower 90-day mortality compared with
those receiving MT alone. In a selected population of patients without prestroke anticoagulation, we demonstrated that
IVT associated with MT might improve functional outcome and recanalization while reducing mortality rates
95% CI, 0.36–0.93). |
Helps answer the question on IVT or not with MT. Trial demonstrates that IVT+MT patients in the ASTER trial have lower 90-day mortality compared with those receiving MT alone potentially associated with a selection bias (age and comorbidities). |