| Title: |
Effect of Intravenous Alteplase Treatment on First-Line Stent Retriever Versus Aspiration Alone During Endovascular Treatment |
| Authors: |
Rinkel, Leon A.; Treurniet, Kilian M.; Nieboer, Daan; Kappelhof, Manon; LeCouffe, Natalie E.; Bruggeman, Agnetha A.E.; van Zwam, Wim H.; Lycklama à Nijeholt, Geert J.; Ghariq, Elyas; Uyttenboogaart, Maarten; Dippel, Diederik W.J.; Roos, Yvo B.W.E.M.; Coutinho, Jonathan M.; Majoie, Charles B.L.M.; Emmer, Bart J.; Roozenbeek, Bob; van Es, Adriaan; de Ridder, Inger; van der Worp, Bart; Lo, Rob; Keizer, Koos; Gons, Rob; Yo, Lonneke; Boiten, Jelis; van den Wijngaard, Ido; Hofmeijer, Jeanette; Martens, Jasper; Schonewille, Wouter; Albert Vos, Jan; Tuladhar, Anil; Schreuder, Floris; Boogaarts, Jeroen; Jenniskens, Sjoerd; de Laat, Karlijn; van Dijk, Lukas; den Hertog, Heleen; van Hasselt, Boudewijn; Brouwers, Paul; Sturm, Emiel; Bulut, Tomas; Remmers, Michel; van Norden, Anouk; de Jong, Thijs; Rozeman, Anouk; Elgersma, Otto; Bokkers, Reinoud; van Tuijl, Julia; Boukrab, Issam; Kortman, Hans; Costalat, Vincent |
| Source: |
Stroke ; volume 53, issue 11, page 3278-3288 ; ISSN 0039-2499 1524-4628 |
| Publisher Information: |
Ovid Technologies (Wolters Kluwer Health) |
| Publication Year: |
2022 |
| Description: |
Background: We aimed to assess whether the effect of intravenous alteplase treatment (IVT) before endovascular treatment (EVT) on outcome is modified by first-line technique during EVT in IVT eligible patients. Methods: This was a post hoc analysis from MR CLEAN-NO IV (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands - Intravenous Treatment Followed by Intra-Arterial Treatment Versus Direct Intra-Arterial Treatment for Acute Ischemic Stroke Caused by a Proximal Intracranial Occlusion), a randomized trial of IVT followed by EVT versus EVT alone in patients presenting directly to EVT-capable centers. We included data from all patients who underwent EVT with a thrombectomy attempt. We compared patients treated with stent retriever (with or without aspiration) to aspiration alone as first-line EVT technique and assessed the interaction of first-line EVT technique with IVT treatment. Primary outcome was the 90-day modified Rankin Scale score, analyzed with mixed model ordinal regression for a shift towards better outcome. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2b–3). Results: Of 473 included patients, 102 (21.6%) were treated with aspiration alone as first-line technique. In the full population, functional outcome was similar for patients treated with stent retriever versus aspiration only (adjusted common odds ratio [acOR]‚ 1.07 [95% CI, 0.69–1.66]). We observed a significant interaction between IVT and first-line EVT technique ( P =0.03). In the aspiration-only group, patients treated with EVT alone had worse functional outcome compared to those treated with IVT and EVT (acOR, 0.44 [95% CI, 0.21–0.90]). In the stent retriever group, functional outcome did not differ between patients treated with or without IVT (acOR, 1.08 [95% CI, 0.74–1.57]). There was no statistically significant interaction for successful reperfusion. Conclusions: In MR CLEAN-NO IV, the treatment effect of IVT was modified ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1161/strokeaha.121.038390 |
| DOI: |
10.1161/STROKEAHA.121.038390 |
| Availability: |
https://doi.org/10.1161/strokeaha.121.038390; https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.121.038390 |
| Accession Number: |
edsbas.18FFA211 |
| Database: |
BASE |