Endovascular Treatment With or Without Prior Intravenous Alteplase for Acute Ischemic Stroke. Issue 11 (4th June 2019)

• Record Type: Journal Article
• Authors: Chalos, Vicky; LeCouffe, Natalie E.; Uyttenboogaart, Maarten; Lingsma, Hester F.; Mulder, Maxim J. H. L.; Venema, Esmee; Treurniet, Kilian M.; Eshghi, Omid; van der Worp, H. Bart; van der Lugt, Aad; Roos, Yvo B. W. E. M.; Majoie, Charles B. L. M.; Dippel, Diederik W. J.; Roozenbeek, Bob; Coutinho, Jonathan M.
• Other Names: van Oostenbrugge Robert J. investigator.; van Zwam Wim H. investigator.; Boiten Jelis investigator.; Vos Jan Albert investigator.; Jansen Ivo G. H. investigator.; Goldhoorn Robert‐Jan B. investigator.; Schonewille Wouter J. investigator.; Wermer Marieke J. H. investigator.; van Walderveen Marianne A. A. investigator.; Staals Julie investigator.; Hofmeijer Jeannette investigator.; Martens Jasper M. investigator.; Lycklama à Nijeholt Geert J. investigator.; Emmer Bart J. investigator.; de Bruijn Sebastiaan F. investigator.; van Dijk Lukas C. investigator.; Lo Rob H. investigator.; van Dijk Ewoud J. investigator.; Boogaarts Hieronymus D. investigator.; de Kort Paul L. M. investigator.; Peluso Jo J. P. investigator.; van den Berg Jan S. P. investigator.; van Hasselt Boudewijn A. A. M. investigator.; Aerden Leo A. M. investigator.; Dallinga René J. investigator.; Schreuder Tobien H. C. M. L. investigator.; Heijboer Roel J. J. investigator.; Keizer Koos investigator.; Yo Lonneke S. F. investigator.; den Hertog Heleen M. investigator.; Sturm Emiel J. C. investigator.; Sprengers Marieke E. S. investigator.; Jenniskens Sjoerd F. M. investigator.; van den Berg René investigator.; Yoo Albert J. investigator.; Beenen Ludo F. M. investigator.; Roosendaal Stefan D. investigator.; van der Kallen Bas F. W. investigator.; van den Wijngaard Ido R. investigator.; van Es Adriaan C. G. M. investigator.; Bot Joseph C. J. investigator.; van Doormaal Pieter‐Jan investigator.; Flach H. Zwenneke investigator.; el Ghannouti Naziha investigator.; Sterrenberg Martin investigator.; Puppels Corina investigator.; Pellikaan Wilma investigator.; Sprengers Rita investigator.; Elfrink Marjan investigator.; de Meris Joke investigator.; Vermeulen Tamara investigator.; Geerlings Annet investigator.; van Vemde Gina investigator.; Simons Tiny investigator.; van Rijswijk Cathelijn investigator.; Messchendorp Gert investigator.; Bongenaar Hester investigator.; Bodde Karin investigator.; Kleijn Sandra investigator.; Lodico Jasmijn investigator.; Droste Hanneke investigator.; Wollaert M. investigator.; Jeurrissen D. investigator.; Bos Ernas investigator.; Drabbe Yvonne investigator.; Zweedijk Berber investigator.; Khalilzada Mostafa investigator.; Compagne Kars C. J. investigator.; Geuskens Ralph R. investigator.; van Straaten Tim investigator.; Ergezen Saliha investigator.; Harmsma Roger R. M. investigator.; de Jong Anouk investigator.; Hinsenveld Wouter investigator.; Berkhemer Olvert A. investigator.; Boers Anna M. M. investigator.; Groot P. F. C. investigator.; Mens Marieke A. investigator.; van Kranendonk Katinka R. investigator.; Kappelhof Manon investigator.; Tolhuijsen Manon L. investigator.; Alves Heitor investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 8:Issue 11(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-06-04
• Subjects: endovascular treatment -- large vessel occlusion -- stroke -- thrombectomy -- thrombolysis; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.118.011592
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: It is unclear whether intravenous thrombolysis (IVT) with alteplase before endovascular treatment (EVT) is beneficial for patients with acute ischemic stroke caused by a large vessel occlusion. We compared clinical and procedural outcomes, safety, and workflow between patients treated with both IVT and EVT and those treated with EVT alone in routine clinical practice. Methods and Results: Using multivariable regression, we evaluated the association of IVT+EVT with 90‐day functional outcome (modified Rankin Scale), mortality, reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage in the MR CLEAN (Multicenter Randomised Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry. Of 1485 patients, 1161 (78%) were treated with IVT+EVT, and 324 (22%) with EVT alone. Patients treated with IVT+EVT had atrial fibrillation less often (16% versus 44%) and had better pre‐stroke modified Rankin Scale scores (pre‐stroke modified Rankin Scale 0: 73% versus 52%) than those treated with EVT alone. Procedure time was shorter in the IVT+EVT group (median 62 versus 68 minutes). Nontransferred IVT+EVT patients had longer door‐to‐groin‐puncture times (median 105 versus 94 minutes). IVT+EVT was associated with better functional outcome (adjusted common odds ratio 1.47; 95% CI: 1.10–1.96) and lower mortality (adjusted odds ratio 0.58; 95% CI: 0.40–0.82). Successful reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage did not differ between groups. Conclusions: In this observational study, patients treated with IVT+EVT had better clinical outcomes than patients who received EVT alone. This finding may demonstrate a true benefit of IVT before EVT, but its interpretation is hampered by the possibility of residual confounding and selection bias. Randomized trials are required to properly assess the effect of IVT before EVT.