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Comment & Response
August 2017

Mechanical Thrombectomy After Intravenous Thrombolysis vs Mechanical Thrombectomy Alone in Acute Stroke—Reply

Author Affiliations
  • 1Department of Neurology, University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands
  • 2Divisions of Neuroradiology and Neurosurgery, Departments of Medical Imaging and Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
JAMA Neurol. 2017;74(8):1015. doi:10.1001/jamaneurol.2017.1343

In Reply We read with interest the letter by Seners and colleagues regarding our recent publication.1 The possibility of early recanalization among patients with acute ischemic stroke and a proximal intracranial occlusion was underestimated in the recent trials on mechanical thrombectomy (MT) because vascular imaging was in part done after starting intravenous thrombolysis (IVT), particularly in the MR CLEAN trial.2 However, Seners et al3 observed higher recanalization rates for M1 and M2 occlusions at an early stage, but this was not the case for carotid occlusions.3 Additionally, they defined early recanalization as happening within 3 hours of the start of IVT. Currently, MT has become standard of care and centers are trying to reduce treatment delays; one may wonder if recanalization 3 hours after starting IVT can still be considered “early.” Another limitation of their meta-analysis is that they included a very heterogeneous set of studies. Baseline methods, follow-up imaging, the timing of follow-up imaging, and the scores for recanalization had all differed considerably between these studies.3 This heterogeneity is also exemplified by the observed rates of early recanalization that varied between 6% and 53%. These limitations make it difficult to translate the results of this meta-analysis to current clinical practice.