Clinical efficacy and safety evaluation of intravenous thrombolysis combined with carotid artery stenting in the treatment of acute cerebral infarction

Abstract

Objective: To evaluate the clinical efficacy and safety of intravenous thrombolysis (IVrtPA) combined with carotid artery stenting (CAS) in the treatment of acute cerebral infarction (ACI).

Methods: We conducted a single-center retrospective cohort of consecutive adults with anterior-circulation large- vessel occlusion (LVO) and ipsilateral carotid disease between March 2021 and March 2023. Patients receiving intravenous thrombolysis (IVT; alteplase 0.9 mg/kg; 10% bolus then 60-min infusion) plus mechanical thrombectomy (MT) were classified as the control group; those additionally undergoing carotid artery stenting (CAS) for flow-limiting extracranial internal carotid artery (ICA) lesions comprised the intervention group. The primary outcome was good functional outcome (modified Rankin Scale [mRS] 0–2) at 90 days. Safety outcomes were intracranial hemorrhage (ICrH) within 24 h and cumulative ICrH through 7 days. Secondary outcomes included 30-day reinfarction, 90-day all-cause mortality, and 12-month stent patency (duplex/CTA).

Result: Among 120 patients (intervention n=40; control n=80), the 90-day mRS 0–2 rate was 70% (28/40) vs 50% (40/80) (P=0.037). Day-7 NIHSS improvement was larger with IVT+MT+CAS (8.03 ± 1.15 vs 5.39 ± 2.07; P<0.001). ICrH at 24 h (10.0% vs 7.5%) and cumulative ICrH through 7 days (10.0% vs 7.5%) did not differ significantly. Thirty-day reinfarction and 90-day mortality showed no statistically significant differences. Twelve month stent patency was 90% (36/40).

Conclusion: In LVO with significant carotid disease, adding CAS to IVT+MT was associated with improved early neurological recovery and high 12-month stent patency without an excess of early ICrH; confirmation in larger, multicenter cohorts is warranted.