{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:07:17Z","timestamp":1773270437116,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2022,6,26]],"date-time":"2022-06-26T00:00:00Z","timestamp":1656201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Current guidelines advocate intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) for all patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). We evaluated outcomes with and without IVT pretreatment. Our institutional protocols allow AIS patients presenting early (&lt;4 h from onset or last seen normal) who have an Alberta Stroke Program Early CT Score (ASPECTS) \u22656 to undergo EVT without IVT pretreatment if the endovascular team is in the hospital (direct EVT). Rates of recanalization and hemorrhagic transformation (HT) and neurological outcomes were retrospectively compared in consecutive patients undergoing IVT+EVT vs. direct EVT with subanalyses in those \u226580 years and \u226585 years. In the overall cohort (IVT+EVT = 147, direct EVT = 162), and in subsets of patients \u226580 years (IVT+EVT = 51, direct EVT = 50) and \u226585 years (IVT+EVT = 19, direct EVT = 32), the IVT+EVT cohort and the direct EVT group had similar baseline characteristics, underwent EVT after a comparable interval from symptom onset, and reached similar rates of target vessel recanalization. No differences were observed in the HT frequency, or in disability at discharge or after 90 days. Patients receiving direct EVT underwent more stenting of the carotid artery due to stenosis during the EVT procedure (22% vs. 6%, p = 0.001). Direct EVT and IVT+EVT had comparable neurological outcomes in the overall cohort and in the subgroups of patients \u226580 and \u226585 years, suggesting that direct EVT should be considered in patients with an elevated risk for HT.<\/jats:p>","DOI":"10.3390\/jcm11133681","type":"journal-article","created":{"date-parts":[[2022,6,26]],"date-time":"2022-06-26T09:00:13Z","timestamp":1656234013000},"page":"3681","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Safety and Efficacy of Intravenous Alteplase before Endovascular Thrombectomy: A Pooled Analysis with Focus on the Elderly"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9489-0133","authenticated-orcid":false,"given":"Asaf","family":"Honig","sequence":"first","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hen","family":"Hallevi","sequence":"additional","affiliation":[{"name":"Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naaem","family":"Simaan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ziv Medical Center, Safed 13100, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzvika","family":"Sacagiu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0069-0323","authenticated-orcid":false,"given":"Estelle","family":"Seyman","sequence":"additional","affiliation":[{"name":"Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-3141","authenticated-orcid":false,"given":"Andrei","family":"Filioglo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moshe J.","family":"Gomori","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ofer","family":"Rotschild","sequence":"additional","affiliation":[{"name":"Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tali","family":"Jonas-Kimchi","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0549-2684","authenticated-orcid":false,"given":"Udi","family":"Sadeh","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anat","family":"Horev","sequence":"additional","affiliation":[{"name":"Department of Neurology, Soroka University Medical Center, Beer Sheva 84417, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronen R.","family":"Leker","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 E.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Molad","sequence":"additional","affiliation":[{"name":"Department of Stroke and Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy 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Interv. Radiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/13\/3681\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:38:41Z","timestamp":1760139521000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/13\/3681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,26]]},"references-count":26,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11133681"],"URL":"https:\/\/doi.org\/10.3390\/jcm11133681","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,26]]}}}