OBJECTIVES : Mechanical thrombectomy (MT) yields substantial revascularization success rate in ischemic stroke treatment for patients with large vessel occlusions. The present study evaluates the association between recombinant tissue plasminogen activator (rt-PA) use and in-hospital mortality or all-cause 30-day unplanned readmission among MT patients.

METHODS : A retrospective cohort study was conducted using data from Nationwide Readmissions Database (NRD) 2013-2014. Patients with primary diagnosis of ischemic stroke were included. MT and rt-PA were identified by appropriate procedure codes. Records with transfer, same day event status, <1 day of length of stay, and admissions in December were excluded. In-hospital mortality was identified as coded and readmission was calculated based on stroke quality measure documentation. Index admissions were followed within the same year. Multiple demographic, clinical, and hospital related covariates were adjusted in multivariable hierarchical logistic regression model.

RESULTS : In the final cohort, 1,607 patients received MT/rt-PA and 1,712 patients received MT alone. Patients’ characteristics were approximately similar between groups (median age of 70 and 50% female). Mortality and readmission incidences in MT/rt-PA vs. MT group were 15.7% vs. 18.7% and 13.2% vs. 11.7%, respectively. The adjusted odds ratio for the mortality and readmission outcomes were 0.78 (0.65-0.95) and 1.26 (0.99-1.61), respectively (MT as reference).

CONCLUSIONS : Use of rt-PA was associated with lower risk of in-hospital mortality. Hence, rt-PA should still be considered as a first line treatment option for MT eligible patient.