Two recent studies ^1,2 indicated that patients receiving intravenous tissue plasminogen (IV tPA) prior to endovascular thrombectomy (ET) for large vessel occlusion (LVO) do not appear to have better functional outcome at 3 months than patients who only undergo ET alone.

Retrospective cohort study that reviewed data on 149 patients from an ongoing prospectively collected stroke registry. Inclusion criteria was any patient with LVO who was eligible for ET and treated with newer generation stent retriever. The primary outcome was the dichotomized modified Rankin Scale (mRS) at last available follow-up (good mRS=0-2 versus poor mRS=3-6). 

Patients who received IV tPA & ET had a 2.76 higher odds of good mRS outcome at last follow up.  The odds of good mRS outcome decreased by 22% per additional decade in age, and decreased by 11% per each unit increase in NIHSS.

Our model (age, NIHSS, glucose, ASPECTS and use of IV tPA) had the best AUC & predictability for outcome at last follow up.