IMS III trial suggested additional benefit of distal revascularization with addition of IA tPA to mechanical thrombectomy (MT). Eptifibatide has shown to increase the thrombolysis in myocardial infarction. 

Retrospective analysis of all MT patients from January 2014-July 2018 was done. Patients were divided into three groups: Group A (MT only), Group B (MT + IV/IA tPA +/- IA Eptifibatide), and Group C (MT + IA Eptifibatide). We compared NIHSS at presentation, 24 hrs post intervention, at discharge; modified rankin scale (mRS) at 3 months (Good 0-2, Poor 3-6) and symptomatic ICH. GraphPad Quick Calcs Web site was used to obtain descriptive statistics and intergroup differences.

Total of 2423 patients with ischemic strokes that were studied; 262 underwent endovascular interventions; 146 patients received MT. Group A (n=12); Group B (n=88); Group C (n=46). Median NIHSS at presentation, 24 hours and discharge was:  Group A - 19.5, 9 and 4; Group B -17, 11 and 6; Group C - 15, 8 and 4; respectively. Good mRS was reported in 100% patients in Group A (n=5), 52 % patients in Group B (n=29), 73 % in Group C (n=19). Poor mRS (3-6) was reported in 0% Group A (n=0), 48 % in Group B (n=26), 27% in Group C (n=7). Some patients were lost to follow-up.  Symptomatic ICH were 0% in Group A (n=0), 8% in Group B (n=7) and 2% in Group C (n=1). No significant differences in intragroup major complication rates were seen when balanced for historical Cohorts of IVtPA (p=ns). Numbers were not large enough to power the differences in outcomes.

Adjunctive thrombolytic and non-thrombolytic therapy may be useful for improving clinical outcomes in LVOs, without clinically significant increased risk of symptomatic ICH.