الفهرس 
ESSENTIAL NEUROVASCULAR ANATOMYOnly 14 pages are availabe for public view
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Abstract
Stroke is the second leading cause of death and a major cause of disability worldwide. Intravenous thrombolysis (IVT) with alteplase is currently the mainstay of treatment for acute ischemic stroke. The WAKE-UP and EXTEND trials concluded that IV alteplase improves functional outcomes when given in the 4.5 to 9 hour window to patients clinical radiological mismatch and/or DWI-FLAIR mismatch. Mechanical thrombectomy (MT) is the current practice for patients with acute ischemic stroke due to LVO. The DEFUSE 3 and the DAWN trials showed that patients who underwent MT have better functional outcomes than patients treated with standard medical therapy alone if treated up 16 hours and 24 hours respectively after stroke onset. Bridging technique had shown better functional outcomes, lower mortality, higher rate of successful recanalization, higher rates of FPE & lower number of device-passes, and equal odds of symptomatic intracerebral hemorrhage compared with MT alone.
We recruited 50 patients presenting with LVO stroke proved by brain and vascular imaging either CTA or MRA, presenting in the extended time window of 4.5-9 hours from onset. Patients were assigned to two groups either MT alone group or combined MT and IVT group. Clinical outcome assessed by NIHSS and mRS was better in the combined group at discharge, yet there was no significance between two group at 90 days follow up. Also procedural outcome regarding time-to-recanalization and FPE was better in the combined IVT and MT group, denoting the effect of IV Alteplase on thrombi composition and its lytic effect. The incidence of asymptomatic hemorrhagic transformation was higher in the combined IVT and MT group, yet the incidence of symptomatic ICH and mortality was not significantly different between two groups. There was no significant effect of type of large artery affected, technique of MT used, pre-stroke antithrombotic use or type of advanced neuroimaging done on the final outcome of patients in both groups, however collateral score have significant effect on the final clinical, angiographic and radiological outcome of patients.