Abstract TP53: Intravenous Thrombolysis Preceding Mechanical Thrombectomy is Associated With Reduced Procedure Time and Lower Proportion of Fibrin in Retrieved Thrombus

Introduction: Previous studies showed that recombinant tissue plasminogen activator (rt-PA) administration preceding mechanical thrombectomy reduced puncture to recanalization times. Fibrin rich thrombus was associated with extended puncture to recanalization times. Hypothesis: rt-PA administration preceding mechanical thrombectomy is associated with reduced procedure time and low proportion of fibrin in retrieved thrombus Methods: All retrieved thrombus was stained with hematoxylin-eosin. Embolic debris underwent quantitative analysis to quantify three main components: red blood cells, white blood cells and fibrin, by color based segmentation. Patients were assingned to receive either mechanical thrombectomy with rt-PA (IVTMT group) or mechanical thrombectomy alone (MT group). Considering influence by stroke etiology, patients with non-cardioembolism were excluded. Results: From August 2015 to March 2018, 173 consecutive patients were treated in our hospital by MT for acute large vessel occlusion. Histopathologic analysis of retrieved thrombus from 90 patients with acute stroke. 70 patients with cardioembolism were included. Patients were assigned to IVTMT group (n=29) or MT group (n=41). Onset to recanalization time was significantly shorter in IVTMT group than in MT group (median 167 vs 455 minutes; p < 0.01). The other clinical backgrounds were not significantly different. IVTMT group had shorter puncture to recanalization time (median 45 vs 63 minutes; p=0.02), shorter door to recanalization time (median 91 vs 120 minutes; p=0.02). IVTMT group had lower proportion of fibrin in retrieved thrombus (59.6% vs 77.5%, p=0.03). Conclusion: Intravenous thrombolysis preceding mechanical thrombectomy is significantly associated with reduced procedure time and lower proportion of fibrin in retrieved thrombus.