Abstract WP15: Stent Retriever Thrombectomy After Intravenous Tissue Plasminogen versus Intravenous Tissue Plasminogen Activator Alone In Japan : J-ASPECT Japan

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Objective: We performed a nationwide study to evaluate the effectiveness of stent-retriever in addition to intravenous thrombolysis in acute ischemic stroke patients in the ‘‘real-world’’ settings. Methods: This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with acute ischemic stroke who were admitted to hospitals between April 1, 2013, and March 31, 2014 were identified. The rate of functional independence (modified Rankin scale score, 0 to 2) at discharge and mortality at 30 days were compared between patients who received intravenous thrombolysis alone (IVT group) and those who received stent-retriever after intravenous thrombolysis (IVET group) using 1:1 propensity score-matching. Results: In total, 71,519 acute ischemic patients were identified in a year. Among those, 3,367 patients were eligible (3,110 in IVT group and 257 in IVET group). Post-matching, 134 pairs of patients were analysed. The rate of functional independence at discharge was higher in IVET group than in IVT group (odds ratio 1.96, 95% CI 1.16-3.35; p=0.012). In addition, there was no significant differences in mortality at 30 days between the two groups (odds ratio 1.80, 95% CI 0.81-4.23; p=0.153). Conclusion: This nationwide study revealed that mechanical thrombectomy with stent-retriever in addition to intravenous thrombolysis improves functional outcomes in patients with acute ischemic stroke, and with no evidence of increased mortality. A randomized clinical trial seems warranted.

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