Intravenous thrombolysis before thrombectomy improves stroke outcomes

Patients with acute ischemic stroke with a large infarct core -- identified on CT or MRI> -- benefit from treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) over the latter procedure alone, researchers have reported.

The findings are good news for patients suffering stroke, wrote a group led by Imad Derraz, MD, of Montpellier University Medical Center in France. The team's results were published October 17 in Radiology.

"[Our study found that] intravenous thrombolysis before endovascular thrombectomy led to greater odds of good outcomes than endovascular treatment alone following CT- or MRI-identified large vessel occlusive acute ischemic stroke with a large infarct core," the team noted.

Whether the use of IVT before EVT is beneficial in patients with stroke with a large infarct core has been unclear, Derraz and colleagues explained. To address the knowledge gap, the team investigated the impact of IVT treatment before EVT via a study that included 1,408 patients enrolled in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France between January 2015 and January 2022, diagnosed with acute ischemic stroke due to large vessel occlusion and large infarct core treated with EVT. Of the total number of 1,408 patients included in the study, 654 (46.4%) were treated with IVT before EVT.

The research's primary outcome was a modified Rankin Scale score of 0 to 3 at 90 days after the stroke (the tool measures a patient's disability on a scale of 0 to 6, with lower scores translating to higher function). Its secondary outcomes were functional independence (a Rankin score of 0 to 2) and improvement in degree of disability at 90 days post-stroke, as well as early neurologic improvement at 24 hours and successful restoration of blood flow.

The protocol of IVT before EVT translated to higher rates of favorable outcomes at 90 days compared with EVT alone, the group found.

Patient outcomes post stroke, EVT alone compared with IVT plus EVT


EVT alone

IVT plus EVT

Odds ratio (with 1 as reference)


Favorable outcome





Functional independence




< 0.001

Early neurologic improvement





Successful restoration of blood flow





Although the study results are promising, more research is needed, according to the authors.

"Larger prospective data sets, such as those created by randomized clinical trials, are needed to confirm these findings," they concluded.

The complete study can be found here.

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